| Objective:Hashimoto’s thyroiditis (HT) is one of the most common organ specific autoimmune disease. It is the most common cause of subclinical hypothyroidism and subclinical hypothyroidism。HT is often cocurrent with many diseases, such as insulin resistance and metabolic syndrome. The islet function and insulin sensitivity in HT is less studied, and the results are inconsistent. HT is a kind of autoimmune disease. Immune mechanism plays an important role in the pathogenesis of HT. We pretend to study the correlation between peripheral blood regulatory B cells (Bregs), T suppressor cell (Ts cell) ratios and islet function and insulin sensitivity in HT patients.Methods:We recruited 61 cases euthyroid Hashimoto’s thyroiditis patients aged 18-60 years old and 38 cases healthy group matched age and gender. Collected general information, height, weight, waist circumference, hip circumference, blood pressure. All of the subjects carried on oral glucose tolerance test (OGTT). Test the level of glucose, C peptide and insulin in fasting,30min and 120min of OGTT. Besides, test the ratio of CD19+CD24+CD27+B cells, CD19+CD24hiCD38hiB cells, CD19+IL-10+B cells and CD8+CD28T cell in peripheral blood.Result:CD8+T lymphocytes of HT was significantly lower than normal, while CD19+CD24+CD27+B cell subsets increased. With the increase of TPOAb, CD19+CD24hiCD38hiB cells decreased significantly. With the increase of TGAb CD8+CD28- T cells was significantly decreased. There was significant negative correlation between TT3 and CD4+T cells but positive correlated with CD19+CD24hiCD38hiB cells, r=-0.227 and 0.287 respectively; The TT4 was negatively correlated with CD8+CD28" T cells but positive with CD19+CD24+CD27+B cells, r value was-0.267 and 0.298 respectively. Take the 25%-75%of lymphocytes subsets of healthy group as the reference interval. According to the reference range, all the research object was devided into lymphocytes subsets increase group and lymphocytes subsets decrease group. Including age, sex, TT3, TT4, FT3, FT4, TGAb and TPOAb into the Logistic regression equation, TGAb and FT4 were independent risk factors for the proportion decrease of CD8+CD28T cells in lymphocytes; TSH is an independent risk factor for the decrease of CD19+CD24hiCD38hiB cell ratio; FT4 is an independent risk factor for the increase of CD19+CD24+CD27+B cell ratio.Compared with the normal group, HT group had a significantly increase in waist and the secretion of insulin in 2 hours of OGTT. Early phase and total insulin secretion index (InsAUC30/GluAUC30 and InsAUC120/GluAUC120) increased significantly in HT. Fasting insulin secretion index HOMA-J3 of HT group was not increase, the fasting islet function decreased. According to the TPOAb quartile groups, 2 hours insulin secretion (2hINS) of Q3 group was significantly higher than that in Q2 and Q4 group; fasting insulin secretion index (HOMA-β) of Q4 group was lower than that in Ql and Q3 group. With the increase of TPOAb, HO AM-β significantly reduced, showed a linear relationship, r=-0.313; with the increase of TPOAb, fasting islet function index DI also decreased significantly. According to TGAb quartile groups,2h-ins and DI120 in group Q3 were significantly higher than those in Q1 and Q2 groups; with the increase of TGAb, DI decreased significantly, and there was a negative linear correlation between them(r=-0.321, P<0.013). Compared with the control group, HOMA-0, InsAUC30/GluAUC30 and InsAUC120/GluAUC120 of CD8+CD28T lymphocyte increased. DI index increased significantly too. Compared with the control group, systemic sensitivity index (Matsuda) of CD19+CD24hiCD38hiB lymphocyte increased significantly. There was significant negatively correlation between CD19+CD24hiCD38hiB cells ration and Matsuda index (r=-0.398, P=0.010). Compared with the control group, CD19+CD24+CD27+B lymphocyte increasing group had significantly increased HOMA-IR and HOMA-p. There was significant positive correlation between CD19+CD24+CD27+B cells and HOMA-IR (r=0.338, P=0.029). Hyperinsulinemia is defined as fasting insulin (FINS) greater than or equal to 15mU/L, or (and) OGTT2 hours of insulin (2hINS) greater than or equal to 80mU/L. After adjusting of height, weight, waist circumference, hip circumference, blood pressure, We found that CD19+CD24hiCD38hi/L ratio decreased was an independent risk factors for hyperinsulinemia, OR (95%CI) =1.372(1.022-1.843).The DM and IGR prevalence in CD19+CD24hiCD38hi/L decreased group were significantly higher than those in the control group. The IGR prevalence of CD19+CD24+CD27+/L increased group was higher than that of control group; CD19+CD24hiCD38hi/CD19+decreased group had higher TCH and LDL-C level compared with the control group; CD19+CD24hiCD38hi/CD19+were significantly negatively correlated with TCH and LDL-C, r=-0.426 and-0.383 respectively.Conclusion:The euthyroid HT patients had hyperinsulinemia after the meal and decreased fasting islet function. The changes of Bregs and Ts lymphocyte subsets in peripheral blood may play an important role in the pathogenesis. Besides, CD19+CD24hiCD38hiBregs was the independent risk factor for hyperinsulinemia. CD19+CD24hiCD38hi/CD19+decreased group had higher TCH and LDL-C level. CD19+CD24hlCD38hlBregs may both have the immune suppression and disturbances in lipid metabolism, thus increasing HT patients’ insulin resistance. |
PDF Full Text Request