外周血CD3^+T淋巴细胞对习惯性流产患者不良妊娠的预测价值  

Prognostic potential of CD3^+T cells for poor pregnancy outcome in women with recurrent pregnancy failure

作　　者：李慧[1] 廖碧翎[1] 林小红[1] LI Hui;LIAO Bi-ling;LIN Xiao-hong(Department of Gynecology&Obstetrics,Maternity&Child Healthcare Center of Guangdong,Guangzhou 510010)

机构地区：[1]广东省妇幼保健院妇产科

出　　处：《生殖医学杂志》2020年第1期79-84,共6页Journal of Reproductive Medicine

摘　　要：目的探讨习惯性流产(RPL)患者再次妊娠早孕期外周血CD3+T细胞水平与妊娠结局的关系。方法选择2017年12月至2018年10月就诊于我院妇产科的RPL再次妊娠早孕期患者60例为研究对象,选择同期本院常规产检的无既往自然流产史正常早孕妇女50例为对照;收集临床资料,采用流式细胞仪检测两组外周血CD3^+、CD3^+CD4^+、CD3^+CD8^+T细胞水平。根据随访的妊娠结局分为RPL成功分娩组(24例)、RPL再次流产组(36例)和正常成功分娩组(48例),比较各组外周血CD3^+、CD3^+CD4^+、CD3^+CD8^+T细胞水平的差异,分析影响RPL再次流产的危险因素。结果 RPL再次流产组、RPL成功分娩组孕次显著高于正常成功分娩组(P<0.001);RPL再次流产组外周血CD3^+和CD3^+CD4^+T细胞比值显著高于RPL成功分娩组和正常成功分娩组(P<0.05);RPL成功分娩组外周血CD3^+T细胞比值显著高于正常成功分娩组(P<0.05);3组CD3^+CD8^+T细胞比值相比较,差异无统计学意义(P>0.05);单因素和多因素Logistic回归分析显示,CD3^+、CD3^+CD4^+T细胞是影响RPL患者再次流产的独立危险因素(P<0.05);CD3^+T细胞临界值为79.02%时,预测RPL患者再次流产的曲线下面积(AUC)为0.836[95%CI(0.717,0.919)],特异性为91.7%,敏感性为63.9%。结论 RPL患者再次妊娠在早孕期检测外周血CD3^+T细胞将有助于预测患者妊娠结局。Objective:To explore the relationship between the level of CD3^+T cells in peripheral blood and the outcome of pregnancy in patients with recurrent pregnancy loss (RPL).Methods:A total of 60 RPL patients and 50 healthy pregnant women in trimester in Guangdong Women and Children Hospital and Health Institute from Dec 2017 to Oct 2018 were enrolled as objects of study. The clinical data were collected,and the percentages of CD3^+,CD3^+CD4^+ and CD3^+CD8^+T cells were detected by flow cytometry. According to the different pregnancy outcomes,the patients were divided into RPL successful delivery group (n=24),RPL re-miscarriage group (n=36) and normal successful delivery group (n=48). The percentages of CD3^+,CD3^+CD4^+,CD3^+CD8^+T cells were compared among the three groups,The risk factors of RPL recurrent abortion were analyzed.Results:The gravidity in the RPL successful delivery group and RPL re-miscarriage group was significantly higher than that in normal successful delivery group (P<0.05). The percentages of CD3^+ and CD3^+CD4^+T cells in RPL re-miscarriage group were significantly higher than those in the RPL successful delivery group and normal successful delivery group (P<0.05). In addition,the percentage of CD3^+T cells in RPL successful delivery group was significantly higher than that in normal successful delivery group (P<0.05). However,there was no difference in the percentage of CD3^+CD8^+T cells among the three groups (P>0.05). Logistic univariate and multivariate analysis showed that the percentages of CD3^+and CD3^+CD4^+T cells were the independent risk factors for recurrent abortion in patients with RPL (P<0.05). When the percentage of CD3^+T cell threshold was 79.02%,the area under the curve (AUC) for predicting re-abortion in patients with RPL was 0.836 [95%CI (0.717,0.919)],with specificity 91.7% and sensitivity 63.9%.Conclusions:The detection of CD3^+T cells in peripheral blood of RPL patients in early pregnancy is helpful to predict the outcome of pregnancy.

关 键 词：习惯性流产 T淋巴细胞 免疫耐受 CD3+T细胞 

分 类 号：R714.21[医药卫生—妇产科学]