Expression of CD4 + + CD28 null null T lymphocytes in children and adolescents with type 1 diabetes mellitus: Relation to microvascular complications, aortic elastic properties, and carotid intima media thickness

摘要

Background Cardiovascular risk in type 1 diabetes mellitus (T1DM) is associated with endothelial dysfunction, inflammation, and altered immunity. CD4 + CD28 null T‐cells are a subset of long‐lived cytotoxic CD4 + T‐lymphocytes with proatherogenic and plaque‐destabilizing properties. We hypothesized that the frequency of CD4 + CD28 null T‐cells may be altered in T1DM and related to vascular complications. Aim To assess the percentage of CD4 + CD28 null T‐lymphocytes in children and adolescents with T1DM and their relation to vascular structure and glycemic control. Methods Totally 100 patients with T1DM were divided into 2 groups according to the presence of microvascular complications and compared with 50 healthy controls. CD4 + CD28 null T‐lymphocytes were analyzed using flow cytometry. Aortic elastic properties and carotid intima media thickness (CIMT) were assessed. Results Aortic stiffness index and CIMT were significantly higher among patients compared with healthy controls while aortic strain and distensibility were decreased. The percentage of CD4 + CD28 null T‐cells was significantly higher in patients with and without microvascular complications compared with controls. High frequency of CD4 + CD28 null T‐cells was found among patients with microalbuminuria or peripheral neuropathy. Patients with CD4 + CD28 null T‐cells ≥10% had higher HbA1c, urinary albumin creatinine ratio, aortic stiffness, and CIMT. CD4 + CD28 null T‐cells were positively correlated to HbA1c, aortic stiffness index, and CIMT. Conclusions Changes in aortic elastic properties and increased CIMT among young patients with T1DM may enable the recognition of preclinical cardiac impairment. The correlation between CD4 + CD28 null T‐cells and assessed parameters of vascular structure highlights the role of altered immune response in the occurrence of diabetic vascular complications.