The effect of blood glucose levels on programmed death-1 in patients with severe sepsis and type 2 diabetes mellitus / 中华急诊医学杂志

ABSTRACT

Objective To investigate the effect of blood glucose levels on peripheral blood T lymphocyte programmed death-1 factor (PD-1) and the prognosis of 28-day in patients with severe sepsis and type 2 diabetes mellitus (T2DM).Methods A total of 106 severe sepsis patients with T2DM and 50 healthy subjects as controls were included in this prospective study.According to the blood glucose levels at admission,patients were divided into three groupsthe blood glucose ＜ 6.1 mmol/L group,the blood glucose 6.1 to 11.1 mmol/L group,and the blood glucose ＞ 11.1mmol/L group.The patients were followed up for trace the 28-day outcomes,and the levels of peripheral blood PD-1 + CD4 + T lymphocytes and PD-1 + CD8 + T lymphocytes were detected.The Kaplan-Meier survival curves were used to compare the risk of 28-day death in patients with different blood glucose levels.Results The levels of peripheral blood PD-1 + CD4 + T lymphocytes and PD-1 + CD8 + T lymphocytes were higher in patients with severe sepsis and T2DM than those in healthy subjects.The mortality of blood glucose ＜ 6.1 mmol/L group (56.52％) was higher than that of blood glucose 6.1 to 11.1 mmol/L group (24.3％) and the blood glucose ＞ 11.1 mmol/L group (28.3％) (P ＜ 0.05),Kaplan-Meier survival curve showed that the 28-day mortality risk of patients with blood glucose ＜ 6.1 mmol/L was higher than that of patients with blood glucose 6.1 to 11.1 mmol/L group and blood glucose ＞ 11.1 mmol/L group (The Log-rank test values were 6.523 and 5.794,the P values were 0.011 and 0.016).The level of PD-1 + CD8 + T lymphocytes in the blood glucose ＜ 6.1 mmol/L group was higher than that in the blood glucose 6.1 to 11.1 mmol/L group and the blood glucose ＞ 11.1 mmol/L group (P =0.013).Conclusions The patients with severe sepsis and T2DM getting blood glucose level ＜ 6.1 mmol/L at admission may be suffered from severe immunosuppression,and more attention should be paid to the risk of 28-days mortality in these patients..