淋巴细胞主动免疫联合丙种球蛋白治疗复发性流产的研究  

Study on the effectivity of combination treatment with lymphocyte active immunotherapy and intravenous immune globulin of recurrent in abortion patients

作　　者：张艳华[1] 刘梅梅[1] 李佩玲[1] 陈亮[1] 杜伯涛[1] 孙海霞[1] 

机构地区：[1]哈尔滨医科大学附属第二医院妇产科,150086

出　　处：《国际免疫学杂志》2012年第5期398-402,共5页International Journal of Immunology

摘　　要：目的探讨单纯静脉注射免疫球蛋白（IVIG）被动免疫治疗及淋巴细胞主动免疫（LIT）联合静脉注射免疫球蛋白（IVIG）被动免疫治疗对复发性流产患者的治疗效果及对其免疫状态的影响。方法临床确诊为封闭抗体阴性复发性流产患者124例，随机平均分为两组：A组仅接受IVIG，B组接受LIT及IVIG联合治疗，比较两组患者封闭抗体转阳率，临床妊娠率，患者血清淋巴细胞亚群CD3＋、CD43＋、CD83＋水平、CD43＋／CD83＋比率及细胞因子IFN-γ／、IL-10水平和NK细胞含量的变化。结果免疫治疗后，A组封闭抗体转为阳性者45例（72．58％）、B组封闭抗体转为阳性者58例（93．55％），两组之间差异有统计学意义（χ^2=9．688，P〈0．05）；两组成功妊娠率为A组妊娠39例（62．90％），B组妊娠51例（82．26％），两组之间差异有统计学意义（χ^2=5．835，P〈0．05）。接受免疫治疗后B组与A组比较，CD3＋细胞百分比较治疗前升高，有统计学意义（t=2．497，P〈0．05）；CD4＋细胞百分比降低（t=4．514，P〈0．05）；CD8＋细胞百分比升高（t=21．697，P〈0．05）；CD4＋／CD8＋比率降低（t=2．146，P〈0．05），IFN-γ／水平降低（t=4．514，P〈0．05），IL-10则升高（t=21．697，P〈0．05）；外周血NK细胞百分比下降（t=2．146，P〈0．05），B组变化幅度均高于A组，差异具有统计学意义。结论封闭抗体阴性复发性流产患者接受免疫治疗能改善体内细胞免疫状态，具有较好的疗效，LIT联合IVIG治疗较单独应用IVIG效果更好。Objective To investigate clinical effect and immune status of intravenous immune globulin （IVIG） alone or in combination with lymphocyte active immunotherapy （LIT） for treatment of unexplained recurrent spontaneous abortion patients. Methods 124 patients diagnosed with recurrent spontaneous abortion were randomly assigned into two groups for equal numbers. Group A patients （ n = 62 ） were treated with IVIG;while group B （ n = 62） received IVIG and LIT combination treatment. Efficacy was assessed by measurements of blocking antibody （BA） positive rate, the clinical pregnancy rate and lymphocyte subsets levels ： CD3 ＋ T cells, CD4 ＋ T cells CD8 ＋ T cells, as well as levels of IFN-γ, IL-10 and NK cell. Results After Immune treatment, significant difference in BA was found between two groups with 45 cases （ 62.90% ） in group A,and 58 cases（93.55% ）in group B（ χ 2 = 9. 688, P 〈 0. 05）. Significant difference was also found in clinic pregnancy rate （ χ 2 = 5. 835, P 〈 0.05 ） ： 39 cases（62. 90% ） in group A vs. 51 cases（ 82. 26% ） in group B. There was statistical significance in the percentage of CD3 ＋ between group A and group B （ t = 2. 494, P 〈 0.05 ）before and after Immune treatment. However, compared with A group, the percentage of CD4 ＋Tcell was more decreased and the percentage of CD8＋ T cell was more increased in group B（ t = 4.514, t = 21. 697 , P 〈 0. 05, respectively） ;CD4 ＋/CD8 ＋ ratio and IL-10 level and NK cell percentage were more decreased in group B （ t = 2. 146, t = 21. 697, t = 2. 146, P 〈 0.05 respectively） ; the level of IFN-γ was more increased in group B（ t =4. 514, P 〈0. 05）. There is a statistical significance on these items, in which group B is higher than group A. Conclusions Immune treatment may act as an effective and safe method for treatment of recurrent spontaneous abortion patients with negative BA. In addition, combination therapy with LIT and IVIG was more effective than IVIG alone.

关 键 词：淋巴细胞主动免疫 复发性流产 丙种球蛋白 封闭抗体 

分 类 号：R714.21[医药卫生—妇产科学]