目的：探讨增殖性糖尿病视网膜病(proliferative diabetic retinopathy，PDR)患者外周血CD4⁺ CD25⁺ T细胞及相关基因FOXP3表达变化意义，观察其在PDR发病中的临床意义。

方法：采用流式细胞术检测PDR患者及正常对照外周血CD4⁺CD25⁺T细胞比例，Q-PCR测PDR患者、糖尿病和正常人中FOXP3，IL-17和CTLA-4的mRNA表达，并用Wilcoxon秩和检验和直线相关分析法分析PDR患者糖化血红蛋白、年龄、血脂、肾功能的临床资料及它们之间相关度。

结果：PDR患者CD4⁺T细胞降低，CD4⁺CD25⁺T无显著差异，FOXP3和CTLA-4在PDR中下降，IL-17增高。CD4⁺T细胞与年龄相关，CD4⁺CD25⁺T与患者的血肌酐存在正相关性，CD4⁺CD25⁺T细胞水平与年龄、糖化血红蛋白、血脂、血肌酐(Cr)、尿素氮(BUN)均无明显相关性。PDR患者糖化血红蛋白、甘油三酯、总胆固醇、低密度脂蛋白均高于正常值。

结论：CD4⁺CD25⁺T细胞可能参与PDR的发病机制，并且血脂异常提示PDR可能与血脂相关。

AIM:To investigate changes and significance of CD4⁺CD25⁺T cells and expression of FOXP3 mRNA in peripheral blood mononuclear cell(PBMC)from patients with proliferative diabetic retinopathy(PDR)and observe its clinical significance on pathogenesis of PDR.

METHODS: Flow cytometry was used to analyze the proportion of CD4⁺ CD25⁺ T cells in PBMC with PDR and normal control, the expression of FOXP3, IL-17, CTLA-4 mRNA in patients with PDR, diabetes and normal control were detected by Q-PCR. The clinical data of glycosylated hemoglobin(HbA1c), age, blood lipid, renal function and the degree of their relevance were analysed by Wilcoxon rank and inspection, Linear correlation analysis.

RESULTS:CD4⁺ T cells decreased, CD4⁺CD25⁺T with no significant difference, FOXP3 and CLAT-4 decreased in PDR, IL-17 increased in PDR patients. CD4⁺T cells associated with age, the level of CD4⁺CD25⁺T was positive correlation with the patient's serum creatinine(Cr), but had no significant with age, HbA1c, blood lipid, Cr and urea nitrogen(BUN). HbA1c, triglyceride(TG), cholesterol, low density lipoprotein(LDL)were higher than normal value in PDR patients.

CONCLUSION: CD4⁺ CD25⁺ T cells may be involved in the pathogenesis of PDR. In addition, abnormal blood lipid indicate that PDR may be associate with blood lipid level.

国家自然科学基金(No.81371036)