LMWH对复发性流产患者外周血滤泡辅助性T细胞亚群影响的研究  

The effect of LMWH on circulating follicular helper T cells in patients with recurrent spontaneous abortion

作　　者：侯悦 刘倩[1,2] 金大中[1,2] 李佳钋[1,2] 乔宠 HOU Yue;LIU Qian;JIN Da-zhong;LI Jia-po;QIAO Chong(Department of Obstetrics and Gynecology,Shengjing Hospital of China Medical University,Shenyang 110000,China;Research Center of China Medical University Birth Cohort,Shenyang 110000,China)

机构地区：[1]中国医科大学附属盛京医院妇产科,沈阳110000 [2]中国医科大学出生队列研究中心,沈阳110000

出　　处：《现代免疫学》2022年第2期139-144,共6页Current Immunology

基　　金：国家重点研发计划资助(2016YFC1000404);国家自然科学基金面上项目(81771610、8137073);“盛京自由研究者”基金(201706)。

摘　　要：为探讨复发性流产(recurrent spontaneous abortion,RSA)患者外周血CD4^(+)CXCR5^(+)滤泡辅助性T细胞(follicular helper T cell,Tfh)亚群的水平及低分子量肝素(low molecular weight heparin,LMWH)对异常Tfh的作用,收集2018年8月至2019年4月于中国医科大学附属盛京医院就诊的妊娠早期妇女69例作为研究对象,其中健康妇女24例(健康组),未进行LMWH治疗的RSA妇女20例(RSA未治疗组),进行LMWH治疗的RSA妇女25例(RSA治疗组)。FACS检测3组研究对象外周血Tfh亚群百分比。结果显示,RSA未治疗组外周血CD4^(+)CXCR5^(+)Tfh占CD4^(+)T细胞的百分比显著高于健康组[(21.06±9.52)%vs(14.4±3.03)%,P=0.007)]和RSA治疗组[(21.06±9.52)%vs(12.67±4.16)%,P=0.0003),而在RSA治疗组与健康组间差异无统计学意义(P=0.103);RSA未治疗组外周血PD-1^(+)Tfh占CD4^(+)CXCR5^(+)Tfh的百分比显著低于健康组[(3.17±3.12)%vs(7.25±6.34)%,P=0.012]和RSA治疗组[(3.17±3.12)%vs(5.87±5.53)%,P=0.0581],而在RSA治疗组与健康组间差异无统计学意义(P=0.420);ICOS^(+)Tfh占CD4^(+)CXCR5^(+)Tfh的百分比在健康组、RSA未治疗组和RSA治疗组间差异无统计学意义(P=0.279)。由此,Tfh水平异常可能与RSA发病相关,尤其PD-1^(+)Tfh;而LMWH可能通过改善RSA患者异常Tfh百分比调节RSA免疫失衡,具体机制有待进一步研究。To examine the composition of circulating CD4^(+)CXCR5^(+)follicular helper T cell(Tfh)subsets on patients with recurrent spontaneous abortion(RSA)and the effects of low molecular weight heparin(LMWH)on the abnormal Tfh,a total of 69 women in early pregnancy who attended the Department of Obstetrics and Gynecology from Shengjing Hospital Affiliated to China Medical University from August 2018 to April 2019 were enrolled.Among them,there were 24 healthy pregnant women(health group),20 RSA women who were not treated with LMWH(RSA non-treatment group),and 25 RSA women who were treated with LMWH(RSA treatment group).The circulating Tfh cell population of the three groups were compared by FACS.The results showed that the percentage of CD4^(+)CXCR5^(+)Tfh in CD4^(+)T cells was significantly higher in RSA non-treatment group compared to those of healthy control[(21.06±9.52)%versus(14.4±3.03)%,P=0.007)]and RSA treatment group[(21.06±9.52)%versus(12.67±4.16)%,P=0.0003)],while the difference between RSA treatment group and healthy control group was of no statistical significance(P=0.103).The percentage of PD-1^(+)Tfh in CD4^(+)CXCR5^(+)Tfh population was significantly lower in RSA non-treatment group compared to healthy control[(3.17±3.12)%versus(7.25±6.34)%,P=0.012]and RSA treatment group[(3.17±3.12)%versus(5.87±5.53)%,P=0.0581],while there was no significant difference between RSA treatment group and healthy control group(P=0.420).The percentage of ICOS^(+)Tfh in CD4^(+)CXCR5^(+)Tfh was not significantly different among the three groups(P=0.279).Therefore,the abnormal composition of Tfh,especially PD-1^(+)Tfh,may be associated with the pathogenesis of RSA.In addition,LMWH may improve the immune imbalance of RSA by regulating Tfh percentage.However,the detailed mechanism is yet to be elucidated.

关 键 词：复发性流产 低分子量肝素 滤泡辅助性T细胞 

分 类 号：R714.21[医药卫生—妇产科学]