反复妊娠失败患者IVIG治疗后外周血NK细胞变化与妊娠结局的相关性研究  

The relationship between changes of NK cells and pregnancy outcomes after IVIG treatment in women with recurrent pregnancy failure

作　　者：王柳柳 李阳阳 屠韡燕 阮加里 朱丹 鲍时华 Wang Liuliu;Li Yangyang;Tu Weiyan(Shanghai First Maternal and Infant Health Hospital,Tongji University,Shanghai 201204)

机构地区：[1]同济大学附属第一妇婴保健院,上海201204

出　　处：《现代妇产科进展》2018年第10期726-729,共4页Progress in Obstetrics and Gynecology

基　　金：2014年度上海市市级医院新兴前沿技术联合攻关项目(No:SHDC12014129);2017年度上海市医学引导类科技项目(No:17411967800);2014年度上海卫生系统重要疾病联合攻关项目(No:2014ZYJB0003)

摘　　要：目的:分析反复妊娠失败(RPF)患者静脉注射免疫球蛋白(IVIG)治疗后外周血自然杀伤细胞(NK)反应性与妊娠结局的关系。方法:回顾分析2014年至2016年于同济大学附属第一妇婴保健院诊断为RPF且接受IVIG治疗的患者1165例。以NK细胞比例≥24.2%为cut off值纳入141例(占12.1%),其中复发性流产(RSA)患者109例,反复胚胎移植失败(RIF)患者32例。IVIG治疗前后检测患者外周血NK细胞比例,以治疗后NK细胞下降15%为判断治疗反应性分界点,下降<15%为无反应组,下降≥15%为有反应组。分析IVIG治疗后NK细胞的反应性与妊娠结局的关系。结果:57例发生流产,流产率40.43%(57/141)。活产组IVIG治疗前和治疗后NK细胞比例分别为(31.06±6.61)%和(23.61±9.79)%,差异无统计学意义(P>0.05)。IVIG治疗后,RSA患者的活产率明显高于RIF患者,差异有统计学意义(64.22%vs 43.75%,P<0.05)。NK细胞有反应组的活产率显著高于NK细胞无反应组(69.47%vs 39.13%,P<0.05)。进一步调整年龄和BMI,多元回归方程分析发现,IVIG治疗后NK细胞无反应组的流产率是有反应组的7.17倍(OR=7.17,95%CI为1.46～35.27,P=0.02)。结论:外周血NK细胞反应性是评估RPF患者IVIG治疗预后的独立因素。Objective:To investigate the relationship between NK cell reactivity and pregnancy outcome in women with RPF who were treated with immune globulin G intravenous(IVIG).Methods:A total of 1165 women with recurrent pregnancy failure(RPF)were recruited from 2014 to 2016,141 women with NK expansion were enrolled(≥24.2%cut off levels of total lymphocytes),including 109 patients with recurrent spontaneous abortion(RSA)and 32 patients with recurrent implantation failure(RIF).The level of NK cells were detected before and after IVIG administration.Therapeutic effect of IVIG was investigated.Results:The total miscarriage rate was 40.43%(57/141).The level of NK cells before and after IVIG administration were(31.06±6.61)%and(23.61±9.79)%.There was no significant difference(P<0.05).The live birth rate in women with RSA was significantly higher than those with RIF(64.22%vs 43.75%,P<0.05).The live birth rate in women of NK reactive group was significantly higher than those in NK non-response group(69.47%vs 39.13%,P<0.05).After adjusting for covariates,including age and BMI,multiple logistic regression models showed that the miscarriage risk in patients of NK non-response group was 7.17 times higher than those in NK-response group(OR=7.17,95%CI 1.46~35.27,P=0.02).Conclusion:NK cell response is an independent factor to assess the prognosis of IVIG therapy in patients with recurrent pregnancy failure.

关 键 词：静脉用免疫球蛋白 反复妊娠失败 复发性自然流产 反复移植失败 NK细胞 

分 类 号：R714.21[医药卫生—妇产科学]