Large Vascular Lesions With Type 2 Diabetes Mellitus And Regulatory T-cells’ Clinical Study Of Relativity

BackgroundRecently,the prevalence of type 2 diabetes mellitus(T2DM)is estimated at 10.9%of the Chinese adult population.Along with the progress of the disease,50%of T2DM patients died of macrovascular diseases,such as myocardial infarction and cerebral infarction,which seriously affected the quality of life of patients.Therefore,early prevention and treatment of macroangiopathy in T2DM is of great significance.Studies have shown that regulatory T cells are associated with immune diseases.The pathogenesis of T2DM complicated with macrovascular disease related immunity,however,there are few reports about the correlation between regulatory T cells and type 2 diabetes macroangiopathy.Therefore,studying its mechanism is significant for prevention and treatment of macroangiopathy in type 2 diabetes.ObjectiveThis study was to analyze the distribution characteristics and clinical data of peripheral blood CD4+CD25+ regulatory T cells(Tregs)in patients with type 2 diabetes and type 2 diabetes complicated with macroangiopathy.To investigate the correlation of T2DM macrovascular disease and CD4+CD25+Tregs,and to analyze the clinical value of CD4+CD25+Tregs in the early prevention and treatment of T2DM macrovascular disease,we want to find a new method or policy for prevention and treatment of T2DM macrovascular disease.MethodsThe patients admitted to the Department of Endocrinology of Clinical Medicine of Yangzhou University(Northern Jiangsu People’s Hospital)in October 2016-August 2017 were selected.According to the previous medical history,tumor index,fundus examination,autoantibody test,cardiac color Doppler,imaging examination and so on,the complication such as diabetic retinopathy,autoimmune disease,hematological disease,tumor disease and so on,which may affect the CD4+CD25+Tregs level,were excluded.44 patients with T2DM were selected in this research and divided into two groups:23 cases of T2DM without complications(including 15 males and 8 females,group A)and 21 cases of T2DM with macrovascular disease(including 15 males and 6 females,group B).Carotid artery intima thickness is the basis for judging whether or not macrovascular disease is involved.The percentage of CD4+CD25+Tregs between the two groups was detected by BD flow cytometer in the United States by mixing,incubating and centrifugation.The indexes of fasting plasma glucose(FPG),fasting insulin(FINS),hypersensitive C-reactive protein(hs-CRP).erythrocyte sedimentation rate(ESR),urine microalbumin and glycated hemoglobin(HbA1c)were measured in the two groups,and the steady-state model insulin resistance index(HOMA-IR)and BMI(body mass index)were calculated.They were compared between the two groups.Results1.Analysis of general clinical data single factor between two groupsThe course of disease and microalbuminuria were not normal distribution.The four minute interval table was used.All the other indicators are normal distribution,and are expressed as "x±s".Independent Sample T Test showed no statistically significant differences in the duration of course,FPG,age,body mass index(BMI),HbA1c,ESR and Microalbuminuria in the two groups(P≥0.05).However,Group B had lower CD4+CD25+Tregs percentages than group A,HbA1c,HOMA-IR and FINS were higher than group A,The difference was statistically significant(P<0.05).2.Correlation analysis between Tregs and related indexesThe percentage of CD4+ CD25+Tregs are derived from Spearman correlation analysis with related indexes obtains:with BMI(r =-0.071,P = 0.649),HbA1c(r =-0.099,P=0.522),ESR(r = 0.082,P=0.596),hs-CRP(r =-0.265,P = 0.082),FINS(r =-0.448,P=0.002),FPG(r =-0.022,P = 0.887),HOMA-IR(r =-0.344,P = 0.022);It prompts that the percentage of CD4+CD25+Tregs have negative linear relationship with BMI、HbA1c、hs-CRP、FINS、FPG and HOMA-IR,the difference with FINS and HOMA-IR is statistically significant(P<0.05),The other are no statistically significant difference(P ≥0.05).3.Stepwise regression analysis of statistically significant factors in T2DM with large vascular lesionsThe correlation between CD4+CD25+Treg percentage of peripheral blood,hs-CRP,HOMA-IR and T2DM with vascular lesion was examined by logistic regression analysis.There were statistically significant difference between the CD4+CD25+Treg percentage and the T2DM with large vascular lesion(P<0.05),and they were linearly regressive.But hs-CRP and HOMA-IR(P ≥ 0.05)had no statistically significant difference between two groups.ConclusionsThe level of CD4+CD25+Tregs in peripheral blood is negatively correlated with T2DM macroangiopathy,and the decrease in the percentage indicates that the risk of T2DM macroangiopathy is increased.