妊娠期HPV感染孕妇CD4^(+)、CD8^(+)和CD4^(+)CD8^(+)水平与母婴结局的关系

The relationship between the levels of CD4^(+),CD8^(+) and CD4^(+)CD8^(+) in pregnant women with HPV infection during pregnancy and maternal and infant outcomes

目的分析妊娠期人乳头瘤病毒(HPV)感染孕妇T淋巴细胞亚群CD4^(+)、CD8^(+)、CD4^(+)CD8^(+)水平变化情况及与母婴结局的关系。方法收集2018年10月至2020年10月航空总医院收治的96例HPV感染孕妇纳入HPV组,另选取同期76例HPV阴性的正常孕妇作为对照组。比较两组CD4^(+)、CD8^(+)、CD4^(+)CD8^(+)水平变化情况;分析HPV感染孕妇母婴结局情况及其影响因素,并采用ROC曲线分析CD4^(+)、CD8^(+)、CD4^(+)CD8^(+)对HPV感染孕妇母婴结局的预测价值。结果HPV组CD4^(+)、CD4^(+)CD8^(+)水平均低于对照组,CD8^(+)明显高于对照组,差异有统计学意义(P<0.05)。96例HPV感染孕妇中,不良妊娠结局发生率为20.83%(20/96)。单因素分析显示,不良妊娠组高危型HPV感染、CD4^(+)、CD8^(+)、CD4^(+)CD8^(+)水平与正常妊娠组比较具有统计学意义(P<0.05)。经非条件多因素logistic回归模型分析得,年龄>35岁、高危型HPV感染、CD4^(+)降低、CD8^(+)增高、CD4^(+)CD8^(+)降低是导致HPV感染孕妇母婴不良结局的独立危险因素(P<0.05)。ROC曲线显示,CD4^(+)、CD8^(+)及CD4^(+)CD8^(+)联合检测曲线下面积(AUC)、敏感度、特异度均高于各项指标单独检测(P<0.05)。结论妊娠期HPV感染孕妇CD4^(+)、CD8^(+)、CD4^(+)CD8^(+)水平存在异常表达,免疫功能紊乱,三者可作为预测HPV感染孕妇母婴结局的辅助指标。

Objective To analyze the changes in the levels of T lymphocyte subsets CD4^(+),CD8^(+),CD4^(+)CD8^(+)in pregnant women infected with human papillomavirus(HPV)during pregnancy and their relationship with maternal and infant outcomes.Methods 96 pregnant women with HPV⁃infected admitted in Aviation General Hospital from October 2018 to October 2020 were collected and included in the HPV group.Another 76 normal pregnant women with HPV negative during the same period were selected as the control group.Compared the changes of CD4^(+),CD8^(+),CD4^(+)CD8^(+)levels between the two groups;analyzed the mater⁃nal and infant outcomes of HPV infected pregnant women and their influencing factors and used ROC curve to analyze the predictive value of CD4^(+),CD8^(+),CD4^(+)CD8^(+)on the maternal and infant outcomes of HPV infected pregnant women.Results The levels of CD4^(+)and CD4^(+)CD8^(+)in the HPV group were lower than those in the control group,and CD8^(+)was significantly higher than that in the control group,and the difference was statisti⁃cally significant(P<0.05).Among 96 pregnant women with HPV infection,the incidence of adverse pregnan⁃cy outcomes was 20.83(20/96).Univariate analysis showed that the high⁃risk HPV infection,CD4^(+),CD8^(+),CD4^(+)CD8^(+)levels in the poor pregnancy group were statistically significant compared with the normal pregnancy group(P<0.05).Unconditional multivariate logistic regression model analysis showed that age>35 years old,high⁃risk HPV infection,CD4^(+)decrease,CD8^(+)increase,CD4^(+)CD8^(+)decrease were independent risk fac⁃tors leading to the adverse maternal and infant outcome of HPV infection(P<0.05).The ROC curve showed that the area under curve(AUC),sensitivity,and specificity of the combined detection of CD4^(+),CD8^(+)and CD4^(+)CD8^(+)were higher than those of the individual detection(P<0.05).Conclusion CD4^(+),CD8^(+),CD4^(+)CD8^(+)levels in pregnant women with HPV infection during pregnancy and immune dysfunction have abnormal expres⁃sion and immune dysfunction.The three can be used as auxiliary indicators to predict the maternal and infant outcome of HPV⁃infected pregnant women.