目的:观察1型糖尿病(type 1 diabetes mellitus, T1DM)及成人隐匿性自身免疫性糖尿病(latent autoimmune diabetes in adults, LADA)患者外周血中调节性T细胞(regulatory T cells, Treg)、辅助性T细胞17(Helper T cell, Th17)及细胞因子白介素17(interleukin-17, IL-17)的表达水平,并分析其与T1DM胰岛B细胞功能的相关性,从而探讨Th17/Treg在T1DM中的作用。方法:收集2021年12月至2022年6月就诊于蚌埠医学院第一附属医院内分泌科的1型糖尿病、成人隐匿性自身免疫性糖尿病患者及正常健康人共78例,分为T1DM组、LADA组及NC组。ELISA法检测血清IL-17,流式细胞仪检测Th17细胞及Treg细胞比例,比较三组之间各指标的表达差异。结果:T1DM组及LADA组的Treg细胞比例均低于NC组,且T1DM组低于LADA组(P＜0.05)。T1DM组及LADA组的Th17及IL-17表达水平高于NC组(P＜0.05),但T1DM组与LADA组之间差异无统计学意义(P＞0.05)。Pearson相关性分析结果显示,血清IL-17、Th17与FCP及2 h-CP均呈负相关(P＜0.05),Treg与FCP及2 h-CP呈正相关(P＜0.05);以T1DM、LADA、NC为因变量(1=T1DM,2=LADA,3=NC)进行多分类logistic回归分析,结果显示IL-17是T1DM及LADA的危险因素(P＜0.05),Th17为T1DM的危险因素(P＜0.05),Treg为T1DM及LADA的保护因素(P＜0.05)。结论:T1DM及LADA患者体内存在Th17/Treg比值的失衡,表现为Th17及IL-17的表达水平增加并伴有Treg的下降,这与胰岛B细胞功能损伤相关,可能促进T1DM的发生与发展。
Objective: To observe the expression levels of regulatory T cells (Treg), helper T cells 17 (Th17) and cytokine interleukin 17 (IL-17) in peripheral blood of patients with type 1 diabetes mellitus (T1DM) and latent autoimmune diabetes in adults (LADA), with the purpose of exploring the role of Th17/Treg in T1DM by analyzing its correlation with islet-reactive B cells function in T1DM. Methods: A total of 78 cases of T1DM patients, LADA patients and normal healthy people who were admitted in the Endocrinology Department, the First Affiliated Hospital of Bengbu Medical College from December 2021 to June 2022 were selected and divided into the T1DM group, LADA group and normal control (NC) group. Serum IL-17 was detected by ELISA method. Proportions of Th17 and Treg cells were detected by flow cytometry, and the differences of Th17 and IL-17 expression among the three groups were compared. Results: The proportion of Treg cells in the T1DM group and LADA group was significantly lower than that in the NC group, and it was significantly lower in the T1DM group than that in the LADA group. The expression levels of Th17 and IL-17 in the T1DM group and LADA group were significantly higher than those in the NC group, but there was no significant difference between the T1DM group and LADA group. The results of Pearson correlation analysis showed that serum IL-17 and Th17 were negatively correlated with FCP and 2h-CP (IL-17: r/P=-0.273, 0.016, -0.352, 0.002), Treg was positively correlated with FCP and 2h-CP (r/P=0.494/<0.001, 0.575/<0.001). Multivariate logistic regression analysis showed that IL-17 was a risk factor to T1DM and LADA by taking T1DM, LADA, NC as dependent variables(1=T1DM,2=LADA,3=NC), Th17 was a risk factor to T1DM, and Treg was a protective factor to T1DM and LADA. Conclusion: T1DM and LADA patients have unbalanced Th 17 / Treg ratio in vivo, manifested by increased expression level of Th 17 and IL-17 and decreased expression level of Treg, it may be associated with functional impairment of islet-reactive B cells, which could lead to the occurrence and development of T1DM.
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