复发性流产患者子宫内膜组织表达CD57分子的细胞数量与免疫功能及流产的关系  

The Relationship between CD57^(+) Cells Expressed in Endometrium of RSA Patients and Immune Function and Abortion

作　　者：董九华 葛丽娜 茹慧波 张素芝 孙洁 杜丽荣 DONG Jiuhua;GE Li'na;RU Huibo(Hebei Reproductive Health Hospital,Hebei Key Laboratory of Reproductive Medicine,Shjiazhuang Hebei 050000,China)

机构地区：[1]河北省生殖健康医院优生科,河北石家庄050000

出　　处：《实用妇产科杂志》2023年第5期386-390,共5页Journal of Practical Obstetrics and Gynecology

基　　金：河北省医学科学研究计划项目(编号:20210995);河北省省级科技计划(编号:21377799D)。

摘　　要：目的:探讨复发性流产(RSA)患者子宫内膜组织中表达CD57分子的细胞(CD57^(~+)细胞)数量与机体免疫功能及流产的关系。方法:回顾性分析2020年6月至2021年9月河北省生殖健康医院就诊的198例RSA患者的临床资料,分析其子宫内膜CD57^(~+)细胞情况,根据再次妊娠结局计算最优截断值,根据截断值将其中178例患者分为CD57分子低表达组(105例)和CD57分子高表达组(73例),对两组患者外周血淋巴细胞亚群进行比较。将再次妊娠的68例患者分为持续妊娠组(45例)和流产组(23例),比较两组外周血淋巴细胞亚群及一般资料,并行多因素Logistic回归分析。结果:(1)198例RSA患者子宫内膜CD57^(~+)细胞阳性率为84.3%(167/198),CD57^(~+)细胞数均值为4.52个/HPF,中位数为4.00个/HPF。(2)CD57分子高表达组的总T淋巴细胞、Th细胞、NK细胞、Th1亚群细胞数量显著高于低表达组,差异有统计学意义(P<0.05)。(3)持续妊娠组与流产组比较,仅不同的CD57^(~+)细胞数和年龄的差异有统计学意义(P<0.05);Logistic回归分析结果显示:年龄(OR 1.24,95%CI 1.04~1.49)和CD57^(~+)细胞数(OR 3.93,95%CI 1.05~14.74)是影响RSA患者持续妊娠的独立危险因素(P<0.05)。结论:RSA患者子宫内膜CD57^(~+)细胞数量与机体免疫功能以及流产率有关,子宫内膜CD57^(~+)细胞数有助于RSA患者妊娠预后的预测,并为临床开展免疫治疗提供依据。Objective:To investigate the relationship between the number of CD57^(~+)cells in the endometrium of patients with recurrent abortion(RSA)and their immune function and abortion.Methods:The clinical data of 198 RSA patients treated by Hebei Reproductive Health Hospital from June 2020 to September 2021 were analyzed retrospectively,and their endometrial CD57^(~+)status was analyzed.The optimal cut-off value was calculated according to the outcome of the second pregnancy.According to the cut-off value,178 patients were divided into a low expression group of CD57(105 cases)and a high expression group of CD57(73 cases).The peripheral blood lymphocyte subsets of the two groups were compared.The 68 cases with second pregnancy were divided into continuous pregnancy group(45 cases)and abortion group(23 cases).The lymphocyte subsets and general data of the two groups were compared,and multivariate logistic regression analysis was performed.Results:①The positive rate of endometrial CD57^(~+)cells in 198 RSA patients was 84.3%(167/198),the mean number of CD57^(~+)cells was 4.52/HPF,and the median was 4.00/HPF.@The number of total T lymphocytes,Th cells,NK cells and Th1 subsets in the CD57 high expression group was significantly higher than that in the CD57 low expression group(P<0.05).③Compared with the abortion group,only the number of CD57^(~+)cells and age in the continuous pregnancy group were significantly different(P<0.05).Logistic regression analysis showed that age(OR1.24,95%CI 1.04-1.49)and the number of CD57^(~+)cells(OR 3.93,95%CI 1.05-14.74)were independent risk factors for persistent pregnancy in RSA patients(P<0.05).Conclusion:The number of CD57^(~+)cells in the endometrium of RSA patients is related to the immune function and the abortion rate.The number of CD57^(~+)cells in the endometrium is helpful to predict the pregnancy prognosis of RSA patients,and provides a basis for immunotherapy.

关 键 词：CD57分子 子宫内膜 免疫功能 复发性流产 妊娠结局 

分 类 号：R715.5[医药卫生—妇产科学]