The Changes Of T Lymphocyte Subsets And Costimulatory Molecules Before And After Shuxuetong Treatment In Type 2 Diabetes Subjects With Diabetic Kidney Disease

Objective 1) To detect the expression of peripheral T lymphocyte subsets and costimulators, and investigate their probalble roles in development of diabetes and diabetic kidney disease. 2) To observe the effects of Chinese medicine Shuxuetong on diabetes and diabetic kidney disease.Methods Flow cytometry was applied to detect CD3, CD4 and CD8 on T lymphocyte surface and the expression of CD4+CD28+T cells, CD8+CD28+T cells and CD4+CD154+T cells on CD3+T lymphocyte surface in peripheral blood before and after two-week Shuxuetong treatment. Totally 85 subjects were devided into DM group (without DKD, n=32), DKD group (n=33) and healthy control group (NC group, n=20). Results 1, There were no significant differences of lipid profile among the 3 groups (P>0.05). FBG(6.93±0.86), HbA1c(7.77±1.39%) and UAER(9.16±6.47) were higher significantly in DM group and FBG(6.74±1.21), HbA1c(7.95±1.36%) and UAER(87.60±48.94) in DKD group than those in NC group (P<0.01). 2, After two-week Shuxuetong treatment,UAER in DM group(9.02±8.12) didn't change (P>0.05),and decreased in DKD group (82.76±45.08), but without significant difference (P>0.05). 3, Compared with NC group, the percentage of CD3+ T cells in DM and DKD group (62.51±5.39%, 62.68±6.51%) was lower (P<0.01) and the level of CD4+T cells (41.49±4.25%, 44.18±4.84%) was higher (P<0.01) significantly, the percentage of CD8+T cells(22.89±2.64%, 21.66±2.89%) was much lower (P<0.01). The ratio of CD4+T/CD8+T (1.84±0.30, 2.08±0.37) in DM and DKD group was higher than that in NC group(1.26±0.17)(P<0.01); CD4+ T cells and the ratio of CD4+T /CD8+T in DKD group were more than that in DM group (P<0.01); CD8+ T cells were less than that in DM group(P<0.05). 4. After the treatment of Shuxuetong, the level of CD4+ T cells in DM group (39.87±4.15%) decrsased(P<0.05) and the level of CD8+ T cells (24.08±3.05%) increased(P<0.05) significantly. In DKD group, the CD4+ T cells (41.15±4.44%) decreased and the CD8+ T cells(23.24±3.12%) increased significantly(P<0.01); the ratio of CD4+T /CD8+T(1.68±0.29,1.79±0.26) in both groups decreased significantly(P<0.01). 5. The levels of CD4+CD28+T in DM(29.92±7.13%) and DKD(32.65±6.77%) group were higher than that in the NC group(P<0.05), the percentage of CD8+CD28+T in both DM and DKD group (16.86±3.52%, 16.47±3.64%) were lower than the NC group (P<0.05). The levels of CD4+CD154+T in DM and DKD group(2.01±0.56%, 2.24±0.67%) were higher than that in the NC group(0.61±0.24%) (P<0.01). 6. The percentage of CD4+CD28+T, CD4+CD154+T in DM group(27.09±5.20%, 1.79±0.58%) decreased (P<0.05) after Shuxuetong therapy, the level of CD8+CD28+T(17.16±2.35%) increased(P<0.05). The percentage of CD4+CD28+T, CD4+CD154+T in DKD group (29.85±6.91%, 1.92±0.67%) decreased (P<0.05), the level of CD8+CD28+T (16.91±1.76%) increased (P<0.01).Conclusions 1. The imbalance of T lymphocyte subsets and changes in the expression of some costimulatory molecules were observed in T2DM patients which are more severe in patients with diabetic kidney disease. It suggests that abnormal changed autoimmune regulators are related with the etiology and development of diabetes and diabetic kidney disease. 2. After treatment with Shuxuetong,the imbalance of T lymphocyte subsets and the abnormal expression of costimulatory molecules recovered, which suggests that the treatment could regulate the immune abnormalities, ameliorate UAER in DKD patients and delay the pathophysiological changes.