目的 观察辅助性T17细胞（Th17）与调节性T细胞（Treg）比值与2型糖尿病（T2DM）患者胰岛素抵抗及胰岛β细胞功能的关系。方法 纳入2022年4月—2023年4月在贵州医科大学第二附属医院内分泌科住院及健康体检人群各100例, 分为糖耐量正常组（NGT组, n=100）和T2DM组（n=100）, 分别测定糖化血红蛋白（HbA1c）、空腹血糖（FPG）、甘油三酯（TG）等生化指标, 电化学发光法测定空腹胰岛素（FINS）, 稳态模型计算胰岛β细胞功能指数（HOMA-β）、胰岛素抵抗指数（HOMA-IR）及胰岛素敏感指数（HOMA-ISI）。流式细胞术检测Th17、Treg水平。HOMA-IR、HOMA-β和HOMA-ISI的影响因素采用多元线性回归分析。结果 与NGT组相比, T2DM组BMI、FPG、HbA1c、LDL-C 、TG、TC、FINS、HOMA-IR、Th17及Th17/Treg水平均升高（P<0.01）, HDL-C、HOMA-β、HOMA-ISI、Treg水平均降低, 且差异有统计学意义（P<0.01）。Th17与BMI（r=0.251, P<0.001）及HOMA-IR（r=0.305, P<0.001）呈正相关; 与HOMA-β（r=-0.204, P<0.001）及HOMA-ISI（r=-0.359, P<0.001）呈负相关。Treg与HOMA-ISI之间呈正相关（r=0.170, P=0.008）, 而与HOMA-IR呈负相关（r=-0.153, P=0.017）; Th17/Treg与BMI（r=0.332, P<0.001）及HOMA-IR（r=0.374, P<0.001）;与HOMA-β（r=-0.249, P<0.001）及HOMA-ISI（r=-0.427, P<0.001）呈负相关。多元线性回归分析显示, Th17/Treg是HOMA-IR（β=5.915）升高及HOMA-ISI（β=-2.557）下降的影响因素（P<0.01）。结论 Th17/Treg可能通过影响胰岛素抵抗、降低胰岛素敏感性参与T2DM的发生。

Objective To explore the relationship among the proportion of helper T17 cells（Th17）to regulatory T cells（Treg）, insulin resistance, and the function of islet beta cells．Methods One hundred cases of hospitalized patients and 100 cases of health check-ups people in the Department of Endocrinology of the Second Affiliated Hospital of Guizhou Medical University from April 2022 to April 2023 were included．Patients were divided into normal glucose tolerance group（NGT group, n=100）and type 2 diabetes mellitus group（T2DM group, n=100）．The biochemical indexes of HbA1c, fasting blood glucose（FPG）, triglyceride（TG）and fasting insulin（FINS）were determined by electrochemiluminescence．Islet beta cell function index（HOMA-β）, insulin resistance index（HOMA-IR）and insulin sensitivity index（HOMA-ISI）were calculated in homeostasis model．The levels of Th17 and Treg were detected by flow cytometry．Spearman was used to analyze the correlation between indicators, and multiple linear regression analysis was used to analyze the influencing factors of HOMA-IR, HOMA-β and HOMA-ISI．Results In contrast to the NGT group, the T2DM group exhibited elevated levels of BMI, FPG, HbA1c, LDL-C, TG, TC, FINS, HOMA-IR, Th17 and Th17/Treg, with these variances being signifincantly different（P<0.01）．There was a notable reduction in the levels of HDL-C,HOMA-β,HOMA-ISI,Treg,with those changes being significantly different（P<0.01）．Th17 was positively correlated with BMI（r=0.251, P<0.001）and HOMA-IR（r=0.305, P<0.001）, it was negatively correlated with HOMA-β（r=-0.204, P<0.001）and HOMA-ISI（r=-0.359, P<0.001）．Treg was positively correlated with HOMA-ISI（r=0.170, P=0.008）, while it was negatively correlated with HOMA-IR（r=-0.153, P=0.017）．The ratio of Th17/Treg was positively correlated with BMI（r=0.332, P<0.001）and HOMA-IR（r=0.374, P<0.001）, it was negatively correlated with HOMA-β（r=-0.249, P<0.001）and HOMA-ISI（r=-0.427, P<0.001）．Multiple linear regression analysis showed that Th17/Treg was an influential factor in the increase of HOMA-IR（β=5.915）and the decrease of HOMA-ISI（β=-2.557）（P<0.01）．Conclusions Th17/Treg may be involved in the development of T2DM by affecting insulin resistance and reducing insulin sensitivity．

目的 分析石河子地区2型糖尿病(T2DM)合并消化道恶性肿瘤患者的临床特征,探讨T2DM合并消化道恶性肿瘤的影响因素。方法 ①纳入我院2015年至今消化道恶性肿瘤患者为研究对象。根据OGTT结果或既往有无T2DM病史分为三组:健康对照组(A组),消化道恶性肿瘤组(B组),T2DM合并消化道恶性肿瘤组(C组)。②全自动生化分析仪测定血清中糖脂代谢指标,化学发光法测定血清甲胎蛋白(AFP)等肿瘤标志物,分析其临床特征,进行组间比较,并探讨其影响因素。采用SPSS 22.0软件处理数据,并进行方差分析;影响因素采用Logistic回归分析;假设检验水准α＝0.05,双侧检验P<0.05差异有统计学意义。结果 ①基线资料比较显示:A组310例(男女比138/172),年龄(52.96±10.98)岁;B组513例(男女比343/170),胃癌患者居多(26.90%),年龄(62.26±12.34)岁;C组134例(男女比80/54),肝癌患者较多(26.12%),年龄(66.78±10.47)岁;与A组相比,B组与C组男性患者较多,年龄较大。②组间基线资料比较显示:三组的性别、年龄存在统计学差异(P<0.001)。③协方差分析消除影响因素后:与A组相比,B组及C组的TG、 TC、HDL-c降低(P<0.001);FPG、AFP、CEA、CA12-5、CA15-3、CA19-9、CA72-4升高(P<0.01)。④Logistic回归分析后结果显示:FPG为消化道恶性肿瘤发生的独立危险因素(OR=1.204);年龄是消化道恶性肿瘤及T2DM合并消化道恶性肿瘤发生的危险因素(OR=1.072,1.105),HDL-c为消化道恶性肿瘤及T2DM合并消化道恶性肿瘤发生的保护因素(OR=0.200,0.111);结论 老年男性T2DM患者易发生消化道恶性肿瘤。因此,对于高龄男性T2DM患者,尤其是HDL-c降低的情况下,应进行相关筛查,以早期防治消化道恶性肿瘤的发生发展。

Objective To analyze the clinical characteristics of patients with type 2 diabetes mellitus (T2DM)complicated with gastrointestinal malignancy in Shihezi area, and investigate the influencing factors of T2DM complicated with gastrointestinal malignancy. Methods ①Patients with malignant tumors of the digestive tract in our hospital from 2015 to the present have been included in the study. They were divided into three groups based on OGTT results or previous history of T2DM: healthy control group (group A), gastrointestinal malignant tumor group (group B), and T2DM combined gastrointestinal malignant tumor group (group C). ②Automatic biochemical analyzer measured serum glucose and lipid metabolism indicators, chemiluminescence method was used to measure serum alpha-fetoprotein (AFP)and other tumor markers, to analyze its clinical characteristics, make a comparaison between groups, and explore its influencing factors. The data was processed with SPSS 22.0 software and analysis of variance was performed; the influencing factors were analyzed by logistic reg-ression; hypothesis test level = 0.05, and the two-sided test P <0.05 was statistically significant. Results ①Comparison of baseline data showed that 310 cases (male/female 138/172)in group A were (52.96±10.98)years old. In group B, 513 patients (male/female 343/170)were diagnosed with gastric cancer (26.90%), aged (62.26±12.34)years. There were 134 cases in group C (male/female 80/54), with more liver cancer patients (26.12%), and the age was (66.78±10.47)years. Compared with group A, group B and group C had more male patients and were older. ②Comparison of baseline data among groups showed there were statistical differences in gender and age among the three groups (P<0.001). ③After covariance analysis eliminated influencing factors: compared with group A, TG, TC and HDL-c were decreased in group B and group C (P<0.001). FPG, AFP, CEA, CA12-5, CA15-3, CA19-9, and CA72-4 increased (P<0.01). ④Logistic regression analysis results: FPG was an independent risk factor for gastrointestinal malignancy (OR=1.204). Age wss a risk factor for gastrointestinal malignancy and T2DM complicated with gastrointestinal malignancy (OR=1.072, 1.105), HDL-c was the protective factor (OR=0.200, 0.111). Conclusion Elderly male T2DM patients are prone to gastrointestinal malignancies. Therefore, for elderly men with T2DM, especially when HDL-c is reduced, relevant screening should be performed to prevent and control the occurrence and development of gastrointestinal malignant tumors in the early stage.