辅助性T淋巴细胞亚型与妊娠期肝内胆汁淤积症发病的关系  

Study of relationship between T helper cell type-1 and type-2 cytokines and intrahepatic cholestasis of pregnancy

作　　者：彭冰[1] 刘淑芸[1] 

机构地区：[1]四川大学华西第二医院妇产科,成都610041

出　　处：《中华妇产科杂志》2002年第9期516-518,共3页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的　探讨辅助性T淋巴细胞 (TH) 1型细胞因子 [γ干扰素 (IFN γ)、肿瘤坏死因子α(TNF α) ]及TH2 型细胞因子 [白细胞介素 4(IL 4) ]与妊娠期肝内胆汁淤积症 (ICP)发病的关系 ,从分子免疫学角度探讨ICP的发病机理。方法　采用双抗体夹心酶联免疫吸附法 ,检测 2 0例ICP孕妇 (研究组 )和 2 0例正常妊娠妇女 (对照组 )外周血单个核细胞在植物血凝素刺激下产生TH1型细胞因子(IFN γ ,TNF α)及TH2 型细胞因子 (IL 4)的水平 ,并对TH1型细胞因子与ICP患者血清总胆汁酸的相关性进行分析。结果　 ( 1)研究组孕妇的IFN γ、TNF α水平分别为 ( 63 9± 15 6)ng/L、( 10 2 1± 2 3 1)ng/L ;明显高于对照组孕妇的 ( 464± 147)ng/L、( 72 8± 175 )ng/L ,两组比较 ,差异有极显著性 (P <0 0 0 1)。研究组孕妇的IL 4水平为 ( 2 2± 4)ng/L ,明显低于对照组孕妇的 ( 2 7± 6)ng/L ,两组比较 ,差异有显著性(P <0 0 5 )。 ( 2 )研究组孕妇的TNF α/IL 4比值为 48± 11,明显高于对照组孕妇的 3 0± 8;研究组孕妇的IFN γ/IL 4比值为 3 0± 8,明显高于对照组的 19± 6,两组分别 ,差异均有极显著性 (P <0 0 0 1)。( 3 )研究组孕妇的IFN γ、TNF α水平与ICP患者血清胆汁酸水平呈正相关 ,相关系数 (r)分别为 0 45 8。Objective To investigate the effect of T helper cell type-1(TH 1) cytokines [interferon-γ (IFN-γ), tumor necrosis factor-a (TNF-α)] and T helper cell type-2(TH 2) cytokines [interleukin-4 (IL-4)] on pathogenesis of intrahepatic cholestasis of pregnancy (ICP). Methods The peripheral blood mononuclear cells (PBMC) from 20 cases of ICP patients (study group) and 20 cases of normal pregnant women (control group) were cultured with photohemglutinin stimulation. TNF-α, IFN-γ and IL-4 were determined in the supernatant by enzyme- linked-immunoassay. Results (1) In supernatants of cultured PHA induced PBMC, the levels of IFN-γ and TNF-α of study group were (639±156) ng/L and (1 021±231) ng/L, which were significantly higher than those of control group, (464±147)ng/L and (728±175) ng/L( P<0.001);the IL-4 level of study group was (22±4) ng/L, which was lower than that of control group, (27±6) ng/L(P<0.05);(2) In supernatants, the ratio of TNF-α/IL-4 of study group was 48±11,which was significantly higher than that of control group (30±8), the ratio of IFN-γ/IL-4 of study group was 30±8, which was also higher than that of control group (19±6, P <0.001); (3) There were significant positive correlations between total bile acid and concentrations of the TH 1 cytokines, the correlation coefficients(r) were 0.458 and 0.692, respectively (P <0.01). Conclusions A shift in the balance of cytokine profiles away from TH 1-type reactivity to TH 2-type reactivity occurs in ICP. The enhanced cell-mediated immune reaction disturbs the immune tolerance balance between mother and fetus;The enhanced TH 1-type immune response of ICP may contribute to the damage of hepatic cells and the occurrence of cholestasis.

关 键 词：妊娠并发症 肝内胆汁郁积 T淋巴细胞亚群 细胞活素类 

分 类 号：R714.25[医药卫生—妇产科学]