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目的:观察2型糖尿病下肢血管病变气阴两虚兼血瘀证不同证候积分患者细胞免疫状态并分析其与多重血管危险因素的相关性。方法:根据中医证候积分分级标准,将符合纳入标准的74例患者分为轻、中、重3组,另设10例健康志愿者为对照组,观察各组患者年龄、诊断糖尿病时间、体质指数、血脂、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、稳态模型胰岛B细胞功能指数(HBCI)、超敏C反应蛋白(Hs-CRP)、纤维蛋白原(Fbg)、游离脂肪酸(FFA)、CD4、CD4%、CD8、CD8%、CD4/CD8的变化情况并行多元回归分析CD4、CD8与上述因素的相关性。结果:轻、重组间年龄、HOMA-IR、TG、FFA间比较其差异有统计学意义(P<0.05),轻、重组间及中、重组间诊断糖尿病时间、HbA1c、LDL-c、Fbg方面比较其差异有统计学意义(P<0.05),轻、中、重3组中TG、HDL-c、LDL-c、CD4、CD8分别与健康对照组比较其差异均有统计学意义(P<0.05)。轻、中、重3组间Hs-CRP、CD4、CD8、CD4%比较其差异均有统计学意义(P<0.05);轻、重组间CD8%比较及中度组与重度组CD8%比较其差异有统计学意义(P<0.05);中度组与轻度组及重、轻组间CD4/CD8比较其差异有统计学意义(P<0.05)。CD4与诊断DM时间、HbA1c、LDL-c、HOMA-IR、Hs-CRP呈负相关(P<0.05),CD8与HbA1c、HOMA-IR、TG、LDL-c、Hs-CRP、Fbg、FFA呈正相关(P<0.05)。结论:①2型糖尿病下肢血管病变气阴两虚兼血瘀证患者存在不同的T淋巴细胞分化及分泌细胞因子的改变,②2型糖尿病史的进展及迁延、高糖毒性、脂毒性、胰岛素抵抗等内分泌代谢因素及炎症反应机制的参与可能是该类患者机体细胞免疫状态紊乱的重要病理生理。
OBJECTIVE: To observe the cellular immune status of patients with type 2 diabetes mellitus and lower extremity vascular lesions with different syndromes of Qi-Yin Deficiency Syndrome and Blood Stasis Syndrome and to analyze the correlation with multiple vascular risk factors. Methods: According to TCM syndrome score grading standards, 74 patients meeting the inclusion criteria were divided into three groups: light, medium and heavy, and another 10 healthy volunteers as control group. The age, diagnosis of diabetes mellitus, constitution (HbA1c), insulin resistance index (HOMA-IR), homeostasis model islet B cell function index (HBCI), hypersensitive C-reactive protein (Hs-CRP), fibrinogen (Fbg), free (FFA), CD4, CD4%, CD8, CD8%, CD4 / CD8 were analyzed by multivariate regression analysis of CD4, CD8 and the above factors. Results: The differences of age, HOMA-IR, TG and FFA between light and recombination were statistically significant (P <0.05). There was no significant difference in age, HbA1c, LDL-c and Fbg The differences were statistically significant (P <0.05). There were significant differences in the levels of TG, HDL-c, LDL-c, CD4 and CD8 among the mild, moderate and severe groups 0.05). The differences of Hs-CRP, CD4, CD8 and CD4% between the three groups were statistically significant (P <0.05). Compared with CD8% of light and medium groups and CD8% of moderate and severe groups (P <0.05). The difference of CD4 / CD8 between moderate group and mild group and between severe group and light group was statistically significant (P <0.05). There were negative correlations between CD4 and HbA1c, LDL-c, HOMA-IR and Hs-CRP (P <0.05). CD8 and HbA1c, HOMA-IR, TG, LDL-c, Hs-CRP, Fbg and FFA were positive Related (P <0.05). Conclusion: There are different T lymphocyte differentiation and secretion of cytokines in type 2 diabetic patients with lower extremity vascular lesions of qi and yin and blood stasis syndrome. ②The history and progression of type 2 diabetes mellitus, hyperglycemia, lipotoxicity, insulin resistance and so on The involvement of endocrine and metabolic factors and inflammatory response mechanisms may be an important pathophysiological disorder of cellular immunity in these patients.