外周血CD4^+CD25^+Treg细胞和IL-10水平对复发性流产预测价值  

VALUE OF PERIPHERAL BLOOD CD4^+CD25^+TREG CELLS AND IL-10 LEVEL IN PREDICTING RECURRENT SPONTANEOUS ABORTION

作　　者：袁惠芝[1] 郑玉华[1] 冯敏清[1] 谢佳彬 YUAN Huizhi;ZHENG Yuhua;FENG Minqing;XIE Jiabin(Department of Gynaecology,Maternity and Child Health Care Hospital of Foshan City,Foshan 528000,China)

机构地区：[1]佛山市妇幼保健院妇科

出　　处：《青岛大学学报（医学版）》2019年第5期581-585,共5页Journal of Qingdao University(Medical Sciences)

基　　金：佛山市科技局自筹经费类医学科技攻关项目(2014AB00362)

摘　　要：目的 探讨外周血CD4+CD25+Treg细胞和白细胞介素-10(IL-10)水平对复发性流产(RSA)的预测价值。方法 选取妊娠早期孕妇108例,根据既往病史分为RSA组(50例)和非RSA组(对照组,58例)。检测并比较两组病人外周血CD4+CD25+Treg细胞和IL-10水平,绘制ROC曲线并评估上述指标单独和联合预测RSA的诊断效能。随访20周,比较不同CD4+CD25+Treg细胞和IL-10水平RSA孕妇本次怀孕前28周内再次出现自然流产的情况。结果 RSA组孕妇的CD4+CD25+Treg细胞和IL-10水平均显著低于对照组(t=-8.034、-10.929,P<0.01)。ROC曲线显示,CD4+CD25+Treg细胞和IL-10对RSA具有较高的预测效能,其AUC分别为0.856和0.852,差异无统计学意义(P>0.05)。CD4+CD25+Treg细胞和IL-10联合检测预测RSA的效能显著高于各项指标单独预测(Z=2.557、2.818,P<0.05);Youden指数显示,CD4+CD25+Treg细胞、IL-10以及二者联合预测RSA的最佳截点分别为≤6.412%、≤15.118μg/L和≥0.344。CD4+CD25+Treg细胞和IL-10联合检测的灵敏度为94.00%,显著高于各项指标单独预测的灵敏度(χ^2=5.316、4.332,P<0.05)。随访20周,低水平与高水平CD4+CD25+Treg细胞+IL-10的RSA孕妇本次怀孕自然流产的发生率分别为28%和12%,低水平CD4+CD25+Treg细胞+IL-10的RSA孕妇再发自然流产的风险明显高于高水平CD4+CD25+Treg细胞+IL-10的RSA孕妇,差异有统计学意义(HR=2.611,95%CI=1.085~6.283,P<0.05)。结论 外周血CD4+CD25+Treg细胞和IL-10水平对RSA具有较高预测价值,CD4+CD25+Treg细胞和IL-10联合检测可作为预测既往RSA孕妇再发流产的参考指标,低水平CD4+CD25+Treg细胞+IL-10的RSA孕妇流产复发的可能性更大。Objective To investigate the value of peripheral blood CD4 +CD25 +Treg cells and IL-10 level in predicting recurrent spontaneous abortion (RSA). Methods A total of 108 women in early pregnancy were enrolled, and according to their medical history, they were divided into RSA group with 50 women and non-RSA group (control group) with 58 women. The two groups were compared in terms of the count of CD4 +CD25 +Treg cells and the level of IL-10 in peripheral blood, and the receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficiency of these indicators used alone or in combination in predicting RSA. The women were followed up for 20 weeks, and the recurrence of spontaneous abortion within the first 28 weeks of pregnancy was compared between the RSA pregnant women with different counts of CD4 +CD25 +Treg cells and different levels of IL-10. Results The RSA group had significantly lower count of CD4 +CD25 +Treg cells and level of IL-10 than the control group ( t =-8.034,-10.929;P <0.01). The ROC curve analysis showed that CD4 +CD25 +Treg cells and IL-10 had a high efficiency in predicting RSA, with an area under the ROC curve of 0.856 and 0.852, respectively ( P >0.05). CD4 +CD25 +Treg cells combined with IL-10 had a significantly higher efficiency in predicting RSA than CD4 +CD25 +Treg cells or IL-10 alone ( Z =2.557 and 2.818, P <0.05), and the Youden index showed an optimal cut-off value of ≤6.412% for CD4 +CD25 +Treg cells ≤15.118 μg/L for IL-10 alone, and ≥0.344 for CD4 +CD25 +Treg cells combined with IL-10. CD4 +CD25 +Treg cells combined with IL-10 had a sensitivity of 94.00%, which was significantly higher than the sensitivity of CD4 +CD25 +Treg cells or IL-10 alone (χ^2= 5.316, 4.332;P <0.05). After 20 weeks of follow-up, the incidence rate of spontaneous abortion was 28% in the RSA pregnant women with low CD4 +CD25 +Treg cells and IL-10 and 12% in those with high CD4 +CD25 +Treg cells and IL-10. The RSA pregnant women with low CD4 +CD25 +Treg cells and IL-10 had a signi

关 键 词：T淋巴细胞 调节性 白细胞介素10 流产 习惯性 预测价值 

分 类 号：R714.21[医药卫生—妇产科学]