Xiang Zhongyuan, Liu Wen'en, Fu Sangya, Hu Jingyi, Yang Yanyi
Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha 410008.
Department of Laboratory Medicine, Second Xiangya Hospital, Central South University, Changsha 410011.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2023 Nov 28;48(11):1639-1649. doi: 10.11817/j.issn.1672-7347.2023.230110.
OBJECTIVES: In recent years, the prevalence of diabetic nephropathy (DN) has increased significantly. An increasing number of studies have shown that lymphocyte-associated inflammatory responses play a role in DN. This study aims to investigate the relationship between lymphocytes and DN in patients with autoimmune diabetes. METHODS: The clinical data of 226 patients with Type 1 diabetes (T1D) and 79 patients with latent autoimmune diabetes in adults (LADA) were retrospectively studied and stratified according to the urinary albumin to creatinine ratio (ACR). Risk factors associated with DN were analyzed using correlation analysis and logistic regression. RESULTS: In T1D and LADA patients, systolic blood pressure (SBP), uric acid duration, and diabetes duration in patients with normoalbuminuria were lower or shorter than those in patients with macroalbuminuria (<0.05). The lymphocyte count of T1D patients was significantly higher than that in LADA patients (<0.05), while the neutrophil to lymphocyte ratio (NLR) of T1D patients was significantly lower than that in LADA patients (<0.05). The lymphocyte count in the T1D patients with normoalbuminuria was lower than that those with macroalbuminuria (<0.05). The NLR was lower in the T1D patients with macroalbuminuria than those with microalbuminuria and normoproteinuria (all <0.01). Based on logistic regression analysis, lymphocytes were independently associated with DN in T1D after adjusting for various known risk factors such as course of disease, age, gender, dyslipidemia, hypertension, and smoking status. Analysis of the receiver operating characteristic curve of subjects predicting lymphocytes in normoalbuminuria showed that the area under the curve was 0.601 (95% 0.510 to 0.693, =0.039), and when the cutoff value of lymphocytes was 2.332, the sensitivity was 37.0%, and the specificity was 82.5%. CONCLUSIONS: Lymphocyte counts in autoimmune diabetic patients are closely associated with DN, suggesting that lymphocyte-mediated inflammation may be involved in the pathogenesis of DN in autoimmune diabetic patients. This study provides a possible perspective for using lymphocytes as a potential biomarker for the early identification of individuals at risk for DN and potential therapeutic targets for DN.
目的：近年来，糖尿病肾病（DN）的患病率显著上升。越来越多的研究表明，淋巴细胞相关的炎症反应在DN中起作用。本研究旨在探讨自身免疫性糖尿病患者淋巴细胞与DN之间的关系。 方法：回顾性研究226例1型糖尿病（T1D）患者和79例成人隐匿性自身免疫性糖尿病（LADA）患者的临床资料，并根据尿白蛋白与肌酐比值（ACR）进行分层。采用相关性分析和逻辑回归分析与DN相关的危险因素。 结果：在T1D和LADA患者中，正常白蛋白尿患者的收缩压（SBP）、尿酸病程和糖尿病病程低于或短于大量白蛋白尿患者（<0.05）。T1D患者的淋巴细胞计数显著高于LADA患者（<0.05），而T1D患者的中性粒细胞与淋巴细胞比值（NLR）显著低于LADA患者（<0.05）。正常白蛋白尿的T1D患者的淋巴细胞计数低于大量白蛋白尿患者（<0.05）。大量白蛋白尿的T1D患者的NLR低于微量白蛋白尿和正常蛋白尿患者（均<0.01）。基于逻辑回归分析，在调整了病程、年龄、性别、血脂异常、高血压和吸烟状况等各种已知危险因素后，淋巴细胞与T1D中的DN独立相关。对正常白蛋白尿患者预测淋巴细胞的受试者工作特征曲线分析表明，曲线下面积为0.601（95% 0.510至0.693，P=0.039），当淋巴细胞的临界值为2.332时，敏感性为37.0%，特异性为82.5%。 结论：自身免疫性糖尿病患者的淋巴细胞计数与DN密切相关，提示淋巴细胞介导的炎症可能参与自身免疫性糖尿病患者DN的发病机制。本研究为将淋巴细胞用作早期识别DN风险个体的潜在生物标志物和DN的潜在治疗靶点提供了一个可能的视角。
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