自身抗体阳性复发性流产患者外周血淋巴细胞亚群及细胞因子水平的研究  

Lymphocyte subsets in peripheral blood and cytokine levels in autoantibody-positive patients with recurrent spontaneous abortion

作　　者：吴昕雨 刘道彦 王真真 王淑贞 刘杰 WU Xin-yu;LIU Dao-yan;WANG Zhen-zhen;WANG Shu-zhen;LIU Jie(Department of Clinical Laboratory,Xuzhou Maternity&Child Health Care Hospital Affiliated to Xuzhou Medical University,Xuzhou 221009)

机构地区：[1]徐州医科大学附属徐州妇幼保健院检验科,徐州221009

出　　处：《生殖医学杂志》2024年第10期1332-1339,共8页Journal of Reproductive Medicine

基　　金：徐州医科大学附属医院发展基金项目(XYFM202213)。

摘　　要：目的研究自身抗体阳性复发性流产(RSA)患者外周血淋巴细胞亚群及细胞因子水平的变化及意义。方法回顾分析2020年1月至2022年12月在徐州妇幼保健院就诊的139例RSA患者的临床资料,根据是否合并自身抗体及自身抗体的类型分为6组:抗体阴性对照组(n=41)、抗甲状腺抗体(ATA)阳性组(n=22)、抗磷脂抗体(APLs)阳性组(n=32)、抗核抗体(ANA)阳性组(n=21)、ATA^(+)APLs阳性组(n=10)和ATA^(+)ANA阳性组(n=13)。比较各组患者孕前外周血中淋巴细胞亚群的比例及血清中细胞因子的水平,并按照不同临床特征对各阳性组患者分层分析。结果ATA^(+)ANA阳性组患者血清中IL-2、IL-6水平均显著高于抗体阴性对照组和ATA阳性组(P<0.05);ATA^(+)APLs阳性组患者血清中TNF-α水平显著高于抗体阴性对照组、ANA阳性组和APLs阳性组(P<0.05)。亚组分析中,ATA阳性组中高促甲状腺激素(TSH)亚组CD4^(+)/CD8^(+)比值显著高于正常TSH亚组(P<0.05),而IL-4的水平显著低于正常TSH亚组(P<0.05);APLs阳性组中非标准APLs阳性亚组CD4^(+)/CD8^(+)比值显著低于标准APLs阳性亚组(P<0.05),且CD8^(+)T细胞的比例有升高趋势(P>0.05);ANA阳性组中1∶320抗体滴度亚组CD4^(+)/CD8^(+)比值显著低于1∶100滴度亚组(P<0.05)。结论合并不同类型自身抗体的RSA患者体内免疫功能发生紊乱,主要与细胞因子水平异常以及CD4^(+)/CD8^(+)比值失衡相关。Objective:To investigate the changes and significance of lymphocyte subsets and cytokine levels in the peripheral blood of autoantibody-positive patients with recurrent spontaneous abortion(RSA).Methods:The clinical data of 139 patients with RSA were retrospectively analyzed.According to the presence or absence of autoantibodies and the type of autoantibodies,the patients were divided into six groups as antibody negative control group(n=41),anti-thyroid antibody(ATA)positive group(n=22),anti-phospholipid antibodies(APLs)positive group(n=32),antinuclear antibody(ANA)positive group(n=21),ATA positive combined with APLs positive group(n=10),and ATA positive combined with ANA positive group(n=13).The proportion of lymphocyte subsets in peripheral blood and the levels of cytokines in serum were compared before pregnancy among all groups,and stratified analysis was made for each positive group according to different clinical characteristics..Results:The serum levels of interleukin(IL)-2 and IL-6 in ATA positive combined with ANA positive group were significantly higher than those in control group and ATA positive group(P<0.05).The level of tumor necrosis factor(TNF)-αin the serum of ATA positive combined with APLs positive group was higher than those in antibody negative control group,ANA positive group,and APLs positive group(P<0.05).In subgroup analysis,the CD4^(+)/CD8^(+)ratio of high thyroid stimulating hormone(TSH)subgroup in ATA positive group was higher than that of normal TSH subgroup(P<0.05),and the level of IL-4 was significantly lower than that of normal TSH subgroup(P<0.05).The CD4^(+)/CD8^(+)ratio in the non-criteria APLs positive subgroup was lower than that in the criteria APLs positive subgroup(P<0.05),and the proportion of CD8^(+)T cells showed an increasing trend(P>0.05).The CD4^(+)/CD8^(+)ratio in the ANA positive group with a titer of 1:320 was significantly lower than that in the ANA positive group with a titer of 1∶100(P<0.05).Conclusions:The immune function of RSA patients with different types

关 键 词：复发性流产 自身抗体 细胞因子 淋巴细胞亚群 

分 类 号：R714.21[医药卫生—妇产科学]