不明原因反复妊娠失败患者的免疫学指标分析  

Analysis of immunological indicators in patients with unexplained recurrent pregnancy failure

作　　者：董静[1] 高海慧 王丽芹 潘琳[1] 赵磊[1] Dong Jing;Gao Haihui;Wang Liqin;Pan Lin;Zhao Lei(Department of Rheumatology and Clinical Immunology,the Affiliated Hospital of Qingdao University Qingdao266000,China)

机构地区：[1]青岛大学附属医院风湿免疫科,青岛266000

出　　处：《中华生殖与避孕杂志》2024年第11期1175-1179,共5页Chinese Journal of Reproduction and Contraception

基　　金：山东省医药卫生科技项目(202303111704)。

摘　　要：目的分析不明原因反复妊娠失败患者的免疫学指标,探讨其是否与妊娠失败有相关性。方法采用回顾性研究,分析了2022年1月至2022年6月期间因反复妊娠失败(包含复发性自然流产及反复种植失败)于青岛大学附属医院风湿免疫科就诊的91例患者,采用病例对照研究,从抗核抗体(antinuclear antibody,ANA)是否阳性及自然杀伤(natural killer,NK)细胞是否升高2种不同的角度进行分析,其中ANA阳性组34例,ANA阴性组57例;NK细胞正常组32例,NK细胞升高组59例。收集患者的临床资料、不孕持续时间、流产次数、生化妊娠次数、反复种植失败次数等信息,收集免疫学指标包括ANA、抗可提取核抗原抗体谱、抗磷脂抗体、外周血淋巴细胞亚群、补体、免疫球蛋白、风湿四项等,常规化验包含血常规、尿常规、肝肾功能等,对结果进行统计分析。结果ANA阳性组和阴性组患者在自然胚胎停育次数、移植后胚胎停育次数、妊娠失败总次数、既往合并妇科及慢性疾病等方面差异均无统计学意义(均P>0.05)。ANA阳性组移植后不着床次数为(3.20±2.04)次,明显高于ANA阴性组[(1.47±0.96)次,P=0.004];ANA阴性组的CD19+B细胞比例[(12.96±4.26)%]及CD3-HLA-DR+活化B/NK细胞比例[(14.58±5.45)%]均显著高于ANA阳性组[(10.23±3.54)%,P=0.007;(11.34±4.11)%,P=0.009]。NK细胞正常组与NK细胞升高组在自然胚胎停育次数、移植后胚胎停育次数、妊娠失败总次数等方面差异均无统计学意义(均P>0.05)。结论ANA阳性患者的反复种植失败次数明显升高,外周血NK细胞与妊娠失败的关系尚不明确。Objective:To classify and analyze the immunological indicators of patients with unexplained recurrent pregnancy failure,and explore whether the immunological indicators of these patients were related to pregnancy failure.Methods:We retrospectively studied 91 patients who visited the Rheumatology and Immunology Department of the Affiliated Hospital of Qingdao University from January 2022 to June 2022 due to recurrent pregnancy failures,including recurrent spontaneous abortion and recurrent implantation failures(RIF).We adopted case-control study method.Analysis was conducted from two different perspectives:antinuclear antibody(ANA)positivity and natural killer(NK)cell elevation.Among them,there were 34 ANA positive patients and 57 ANA negative patients;32 patients had normal NK cells and 59 had elevated NK cell.Clinical data,duration of infertility,number of miscarriages,number of biochemical pregnancies,number of recurrent implant failures,and other information from patients were collected.Immunological indicators included ANA,anti-extractable nuclear antigen antibody,antiphospholipid antibodies,peripheral blood lymphocyte subsets,complement,immunoglobulin,rheumatism,etc.Routine laboratory tests included blood routine,urine routine,liver and kidney function,etc.The results were statistically analyzed.Results:There were no statistically significant differences between the ANA-positive and negative groups in terms of the number of spontaneous abortion,the number of post-transplantation abortions,the total number of pregnancy failures,and previous gynecological and chronic diseases(all P>0.05).The number of no-implanting after transplantation in the ANA-positive group was 3.20±2.04,which was significantly higher than that in the ANA-negative group(1.47±0.96,P=0.004).The proportion of CD19+B cells[(12.96±4.26)%]and CD3-HLA-DR+activated B/NK cells[(14.58±5.45)%]in the ANA negative group were significantly higher than those in the ANA positive group[(10.23±3.54)%,P=0.007;(11.34±4.11)%,P=0.009].There were no signi

关 键 词：复发性流产 反复种植失败 抗核抗体 淋巴细胞亚群 自然杀伤细胞 

分 类 号：R714.2[医药卫生—妇产科学]