外周血T淋巴细胞亚群和线粒体损伤指数对卵巢储备功能减退患者妊娠结局的评估价值研究  

Value of peripheral blood T-lymphocyte subsets and mitochondrial damage indexes in assessing pregnancy outcome in patients with diminished ovarian reserve

作　　者：曹文红[1] 卜令真[1] 靳钰 孙芳[1] CAO Wenhong;BU Lingzhen;JIN Yu;SUN Fang(Department of Obstetrics and Gynecology,Women and Children's Hospital Affiliated to Qingdao University,Qingdao,Shandong 266000,China)

机构地区：[1]青岛大学附属妇女儿童医院妇产科,山东青岛266000

出　　处：《国际检验医学杂志》2025年第8期931-936,共6页International Journal of Laboratory Medicine

基　　金：国家卫生健康委医药卫生科技发展研究中心课题(W2020ZT681)。

摘　　要：目的探讨外周血T淋巴细胞亚群和线粒体损伤指数(MDI)对卵巢储备功能减退(DOR)患者妊娠结局的评估价值。方法选取2020年8月至2023年8月该院收治的230例DOR患者纳入DOR组,同期选取230例体检健康的卵巢储备功能正常女性纳入对照组,所有受试者均检测外周血T淋巴细胞亚群及MDI。DOR患者根据临床妊娠情况分为临床妊娠组(n=86)及未临床妊娠组(n=144)。采用多因素Logistic回归模型分析DOR患者妊娠结局的影响因素,采用受试者工作特征(ROC)曲线分析外周血T淋巴细胞亚群及MDI对DOR患者不良妊娠结局的预测价值。结果与对照组比较,DOR组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)降低,CD8^(+)、辅助性T淋巴细胞(Th)-MDI及抑制性T淋巴细胞(Ts)-MDI阳性率升高(P<0.05);230例DOR患者临床妊娠率为37.39%(86/230);与临床妊娠组比较,未临床妊娠组CD4^(+)降低(P<0.05),CD8^(+)、CD4^(+)/CD8^(+)、Th-MDI阳性率及Ts-MDI阳性率升高(P<0.05),两组CD3^(+)比较,差异无统计学意义(P>0.05);未临床妊娠组抗苗勒管激素(AMH)、雌二醇(E2)水平低于临床妊娠组(P<0.05);Th-MDI阳性、Ts-MDI阳性是DOR患者不良妊娠结局的独立危险因素(P<0.05),CD4^(+)/CD8^(+)、AMH、E2高水平是DOR患者不良妊娠结局的保护因素(P<0.05)。AMH、E2、CD4^(+)/CD8^(+)、Th-MDI、Ts-MDI单独及联合应用预测DOR患者不良妊娠结局的曲线下面积分别为0.735、0.784、0.767、0.691、0.703、0.882,其中联合应用的预测效能明显高于各单独应用(P<0.05)。结论DOR患者存在免疫功能紊乱和氧化激活情况,其中CD4^(+)/CD8^(+)低及Th-MDI、Ts-MDI阳性是DOR患者不良妊娠结局的危险因素,检测三者对DOR患者不良妊娠结局具有较高的预测效能。Objective To investigate the value of peripheral blood T-lymphocyte subsets and mitochondrial damage index(MDI)in evaluating the pregnancy outcome of patients with diminished ovarian reserve(DOR).Methods A total of 230 DOR patients admitted to the hospital from August 2020 to August 2023 were selected as DOR group,230 healthy women with normal ovarian reserve function were selected as control group,and all subjects were tested for peripheral blood T-lymphocyte subsets and MDI.DOR patients were divided into clinical pregnancy group(n=86)and non-clinical pregnancy group(n=144)according to clinical pregnancy.The influencing factors of pregnancy outcomes of DOR patients were analyzed by multivariate Logistic regression model,and the predictive value of peripheral blood T-lymphocyte subsets and MDI for poor pregnancy outcomes of DOR patients was analyzed by receiver operating characteristic(ROC)curve.Results Compared with control group,CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in DOR group were decreased(P<0.05),and CD8^(+),positive rate of helper T cell(Th)-MDI and positive rate of suppressor T cell(Ts)-MDI were increased(P<0.05).The clinical pregnancy rate of 230 DOR patients was 37.39%(86/230).Compared with clinical pregnancy group,CD4^(+)in non-clinical pregnancy group was decreased(P<0.05),and CD8^(+),CD4^(+)/CD8^(+)and the positive rates of Th-MDI and Ts-MDI were increased(P<0.05).There was no significant difference in CD3^(+)between two groups(P>0.05).The levels of anti-Müllerian hormone(AMH)and estradiol(E2)in non-clinical pregnancy group were lower than those in clinical pregnancy group(P<0.05).Th-MDI positive and Ts-MDI positive were independent risk factors for poor pregnancy outcomes in DOR patients(P<0.05),and high levels of CD4^(+)/CD8^(+),AMH and E2 were protective factors for poor pregnancy outcomes in DOR patients(P<0.05).The area under the curve of AMH,E2,CD4^(+)/CD8^(+),Th-MDI,Ts-MDI alone and combined in predicting poor pregnancy outcome in DOR patients were 0.735,0.784,0.767,0.691,0.703,0.882,respectivel

关 键 词：卵巢储备功能减退 T淋巴细胞亚群 线粒体损伤指数 妊娠结局 

分 类 号：R446.1[医药卫生—诊断学]