PD-1在2型糖尿病肾病外周血T淋巴细胞中的表达与临床意义-现代医学

PD-1在2型糖尿病肾病外周血T淋巴细胞中的表达与临床意义

单位：南通大学附属常熟医院内分泌科, 江苏常熟 215500

分类号：R587.1

出版年·卷·期（页码）：2024·52·第十二期（1879-1884）

摘要：

目的：旨在调查2型糖尿病肾病(DKD)患者外周血T淋巴细胞上程序性死亡受体1(PD-1)的表达及意义。方法：研究纳入80例健康人群作为NC组，80例首诊2型糖尿病(T2DM)患者作为T2DM组，80例2型DKD的患者作为DKD组，其中DKD组根据尿蛋白肌酐比(UACR)分为中度升高组(A2DKD组，UACR:30～300 mg·g^-1)和重度升高组(A3DKD组，UACR:＞300 mg·g^-1)2个亚组，每个亚组各40例。比较各组外周血T淋巴细胞亚群PD-1的表达，评估肾小球滤过率(eGFR)、肌酐(Scr)及UACR与杀伤性T淋巴细胞PD-1表达的相关性。比较非奈利酮治疗前后DKD组杀伤T淋巴细胞PD-1的表达率。结果：总T淋巴细胞亚群PD-1表达率、辅助T细胞亚群PD-1表达率、杀伤T细胞亚群PD-1表达率和双阴性T细胞亚群PD-1表达率在3组间比较差异有统计学意义(P<0.05)。进一步对亚组PD-1表达率分析发现，A3DKD组的杀伤T细胞亚群的PD-1表达率明显高于A2DKD组与T2DM组(均P＜0.05)。杀伤T细胞亚群的PD-1表达率与UACR水平(r=0.243，95%CI：0.024~0.439)和Scr水平(r=0.507，95%CI：0.323~0.654)均呈正相关(均P＜0.05)，与eGFR水平呈负相关(r=-0.263，95%CI：-0.456~-0.046，P=0.02)。药物治疗后，DKD患者杀伤T细胞亚群PD-1表达率显著下降，差异有统计学意义(P=0.03)。结论：外周血杀伤T细胞亚群PD-1表达升高可导致DKD进展，杀伤T细胞亚群PD-1表达率可作为评估病情的生物学指标。

Objective:To investigate the expression and significance of programmed death receptor 1(PD-1) on T lymphocytes in patients with type 2 diabetic kidney disease(DKD).Methods: 80 healthy controls(NC group), 80 first diagnosis of type 2 diabetes mellitus patients(T2DM group), and 80 type 2 DKD patients(DKD group) were included in this study. According to urinary albumin creatinine ratio(UACR), the DKD group was divided into two subgroups, moderately elevated group(A2DKD group, UACR:30-300 mg·g^-1) and severely elevated group(A3DKD group, UACR:>300 mg·g^-1), with 40 cases in each subgroup. The expression rate of PD-1 on T lymphocytes subsets in peripheral blood were compared among the three groups. The correlation of estimated glomerular filtration rate(eGFR), serum creatinine(Scr) and UACR with expression rate of PD-1 on killer T lymphocytes was evaluated, and the expression rate of PD-1 on killer T lymphocytes of DKD patients before and after finerenone treatment were compared. Results: The expression rates of PD-1 in total T lymphocyte subset, helper T cell subset, killer T cell subset, and double negative T cell subset showed significant differences among the three groups(P<0.05). Further analysis of the expression rate of PD-1 in subgroups was found the expression rate of PD-1 in the killer T cell subset in the A3DKD group was significantly higher than that in the A2DKD group and T2DM group(all P<0.05). The expression rate of PD-1 in killer T cells was positively correlated with UACR(r=0.243, 95%CI:0.024-0.439) and Scr levels(r=0.507, 95%CI:0.323-0.654)(all P<0.05), but negatively correlated with eGFR level(r=-0.263, 95%CI:-0.456--0.046, P=0.02). After drug treatment, the expression rate of PD-1 in killer T cell subsets of DKD patients was significantly decreased(P<0.05). Conclusion: Increased expression of PD-1 in peripheral blood killer T cell subsets can lead to the progression of DKD, the rate of PD-1 expression in killer T cell subsets can be used as a biological indicator to evaluate the disease.

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