不明原因复发性流产患者孕前主动免疫2次前后外周血淋巴细胞亚群及自身免疫性抗体变化的前瞻性研究  

Alteration of lymphocyte subsets and the autoimmune antibodies in peripheral blood before and after two times lymphocyte immunotherapy pre-conception in unexplained recurrent spontaneous abortion

作　　者：侯悦 张凤悦 李媛媛[1] 陈国庆[1] 乔宠[1] HOU Ywe;ZHANG Feng-yue;LI Yuan-yuan;CHEN Guo-qing;QIAO Chong(Department of Obsteries and Gyneoeology,Shengjing Hospital of China Medical University,Shenyang Liaoning 110000,P.R.China)

机构地区：[1]中国医科大学附属盛京医院妇产科,辽宁沈阳110000

出　　处：《中国计划生育和妇产科》2018年第9期28-31,共4页Chinese Journal of Family Planning & Gynecotokology

基　　金：国家自然科学基金项目(项目编号:81771610;81370735)

摘　　要：目的探讨孕前主动免疫2次对不明原因复发性流产(unexplained recurrent spontaneous abortion,URSA)患者外周血淋巴细胞亚群及自身免疫性抗体的影响。方法选取2015年6月至2017年3月在中国医科大学附属盛京医院妇产科门诊确诊为URSA患者51例进行前瞻性研究。患者孕前采用主动免疫治疗2次,应用流式细胞技术和间接免疫荧光法分别检测治疗前后患者外周血淋巴细胞亚群比例和自身免疫性抗体的变化。结果 (1)与治疗前相比,主动免疫2次治疗后患者外周血中T抑制细胞(suppressor T cell,Ts)的百分比上升(P<0.05);辅助性T细胞(helper T cell,Th)的百分比与Th和Ts的比值(Th/Ts)下降(P<0.05);(2)与治疗前相比,主动免疫2次治疗后患者外周血中CD 3^+T细胞的百分率呈上升趋势,自然杀伤细胞(natural killer cell,NK)、B细胞的百分比呈下降趋势,但差异无统计学意义(P>0.05);(3)URSA患者进行主动免疫治疗前自身免疫性抗体均为阴性,2次主动免疫治疗后自身免疫性抗体的阳性率为27.5%(14/51),差异有统计学意义(P<0.05),其中主要是抗核抗体转阳。结论 URSA患者孕前进行主动免疫2次后外周血淋巴细胞亚群中Ts及Th/Ts比值会发生明显变化。但是主动免疫治疗2次后有超过1/4的患者自身免疫性抗体会被短暂激活并转阳,尤其是抗核抗体较为敏感。因此对孕前进行主动免疫治疗的URSA患者要尽早和及时检测主动免疫效果及自身免疫性抗体转阳率,以便于确定下一步治疗方案。Objective To explore the effect of lymphocyte immunotherapy 2 times pre-conception on lymphocyte subsets and autoimmune antibodies in peripheral blood in unexplained recurrent spontaneous abortion（ URSA）. Methods 51 patients with URSA diagnosed at Department of Obstetrics and Gynecology in Shengjing Hospital Affiliated to China Medical University from June 2015 to March 2017 were prospectively selected. Using active immunotherapy 2 times before pregnancy, flow cytometry and indirect immunofluorescence were used to detect the changes of lymphocyte subsets and autoimmune antibodies in peripheral blood before and after treatment. Results （1） After 2 times lymphocyte immunotherapy,the percentage of suppressor T cell（ Ts） was significantly higher compared with that before treatment in peripheral blood（ P〈0. 05）; the ratio of helper T cell（ Th） to Ts in peripheral blood was significantly decreased after the immunotherapy（ P〈0. 05）.（2） After the therapy,the percentage of T cell was increased,whereas the percentage of Th,natural killer cell（ NK） and B cell were decreased,but without statistical significance（ P〈0. 05）.（3）Autoimmune antibodies were negative before lymphocyte immunotherapy. After treatment,the positive rate of autoimmune antibodies,mostly the anti-nuclear antibody,was 27. 5%（ 14/51）,with statistical significance（ P〈0. 05）. Conclusion There are marked changed in peripheral blood lymphocyte subsets,especially Th and Th/Ts,after 2 times lymphocyte immunotherapy preconception.Autoimmune antibodies were transiently activated and turned to positive in more than a quarter patients after treatment,especially ANA. Therefore for patients with URSA who were performed lymphocyte immunotherapy,it is necessary to evaluate the effect of the treatment and monitor the positive rate of autoimmune antibodies to determine the next treatment plan.

关 键 词：不明原因复发性流产 淋巴细胞主动免疫 淋巴细胞亚群 自身免疫性抗体 

分 类 号：R714.21[医药卫生—妇产科学]