免疫性不孕症与慢性生殖道炎症的相关性及中药干预的临床研究

Correlation of Immune Infertility with Chronic Genital Tract Inflammation and Intervention of Chinese Medicine

【目的】探讨慢性生殖道炎症与女性抗精子免疫性不孕的相关性,并评价中药清湿化瘀合剂、益肾活血Ⅰ号方治疗女性抗精子免疫性不孕症的临床疗效。【方法】在200例不孕症患者中筛选出合格受试者58例,将其分为肾虚血瘀组(18例)、湿热瘀结组(20例)和西药组(20例),分别给予益肾活血Ⅰ号方、清湿化瘀合剂及西药治疗,3个月为1个疗程。观察血清抗精子抗体阳性(AsAb+)合并慢性生殖道炎症在不孕症中的分布,观察各组临床疗效及妊娠情况,检测治疗前后血清抗精子抗体阳性(AsAb)定量测定和淋巴细胞亚群、自然杀伤细胞(NK细胞)、白细胞介素-6(IL-6)等指标的变化,以及进行血清AsAb与各因素相关性分析。【结果】(1)AsAb+合并慢性生殖道炎症在不孕症中的分布:200名不孕症患者中AsAb+96例,阳性率为48%,其中122例合并生殖道炎症者中AsAb+62例,占阳性率的64.58%;78例非炎症者中AsAb+34例,占阳性率的35.42%。炎症与非炎症AsAb+阳性率比较,差异有显著性意义(P<0.05)。(2)临床疗效及妊娠情况:肾虚血瘀组、湿热瘀结组、西药组总有效率分别为77.8%、75.0%、70.0%,3组疗效比较,差异无显著性意义(P>0.05)。而肾虚血瘀组治愈5例中妊娠2例,湿热瘀结组治愈7例中妊娠2例,西药组治愈7例中妊娠1例。(3)治疗前后血清AsAb定量测定变化:肾虚血瘀组、湿热瘀结组、西药组治疗后均可使明显升高的血清AsAb水平降低,与治疗前比较,差异有显著性意义(P<0.01),但3组间比较差异无显著性意义(P>0.05)。(4)治疗前后淋巴细胞亚群、NK细胞、IL-6的变化:治疗后肾虚血瘀组和湿热瘀结组CD8+水平升高,CD4+/CD8+及NK细胞水平下降,治疗前后及与西药组比较差异均有显著性意义(P<0.05或P<0.01)。治疗前湿热瘀结组和西药组的血清IL-6水平显著升高,肾虚血瘀组的血清IL-6水平降低,经治疗后湿热瘀结组和西药组的血清IL-6水平降低,肾虚血瘀组的血清IL-6水平有一定程度的升高,与治疗前比较差异有显著性意义(P<0.01),组间比较差异也有显著性意义(P<0.05或P<0.01)。(5)血清AsAb与各因素相关性分析:血清AsAb与IL-6、T淋巴亚群中CD4+/CD8+、炎症程度及炎症病程之间呈显著正相关性。【结论】女性慢性生殖道炎症与AsAb的产生有一定的联系。中药益肾活血Ⅰ号方和清湿化瘀合剂对炎症性抗精子免疫性不孕有效,可能是通过调节Th/Ts(CD4+/CD8+)的偏移来调整机体的免疫功能,使Ts与Th保持平衡,清除AsAb和避免AsAb的进一步产生。

[ Objective ] To explore the correlation of antisperm immune infertility （AII） in females with chronic genital tract inflammation and to observe the therapeutic effect of Chinese medicine of Qingshi Huayu Mixture （QHM） and Yishen Huoxie Prescription Ⅰ （YHP Ⅰ ） for AII. [ Methods] Fifty-eight AII patients were screened from 200 infertility patients, and were randomized into three groups. Group A （N = 18） was treated with YHP Ⅰ , group B （N = 20 ） with QHM and group C （N = 20 ） with western medicine. Three months constituted one treatment course. The incidence of positive antisperm antibody （AsAb^＋） combined with chronic genital tract inflammation, therapeutic effect, pregnancy rate , the content of serum AsAb, as well as the changes of lymphocyte subtypes, natural killer （NK） and interleukin 6 （IL -6） were observed. The correlation of the above indexes with serum AsAb content was also analyzed. [ Results ] （ 1 ） The incidence of positive antisperm antibody （ AsAb^＋ ） combined with chronic genital tract inflammation： There were 96 （48%） with AsAb^＋ in 200 patients, and 62 （64. 58% ） with AsAb^＋ in 122 combined with chronic genital tract inflammation; there were 34 （35.42%） AsAb^＋ patients in 78 without inflammation, the difference of AsAb^＋ incidence was significant between the inflammation patients and the non-inflammation patients （P 〈 0.05 ）. （2） Therapeutic effect and pregnancy rate： The total effective rate was 77.8% , 75.0% and 70.0% in groups A, B and C respectively, the difference being insignificant （P 〉 0.05 ）. There were 2 in 5 cured patients of group A, 2 in 7 of group B and 1 in 7 of group C being pregnancy. （3） Content of serum AsAb： serum AsAb content was decreased in the three groups after treatment, the difference being significant as compared with that before treatment （P 〈 0.01 ） while insignificant between the three groups （ P 〉 0.05 ）. （ 4 ） The changes of lymphocyte subtypes, NK and IL-6 ： CD8 ^＋ was increased, CD4^＋/CD8^＋ and NK were decreased in groups A and B, the differences being significant as compared with those before treatment and those in group C after treatment （P 〈 0. 05 or P 〈 0. 01 ）. Serum IL - 6 level was increased in groups B and C, and decreased in group A before treatment; the treatment of YHP Ⅰ , QHM and western medicine counteracted the above changes, the difference being significant as compared with that before treatment （P 〈0.01 ） and between the three groups after treatment （P 〈0.05 or P 〈0.01 ）. （5） The correlation of the above indexes with serum AsAb content： There existed a positive correlation of the severity and period of inflammation with serum AsAb content, IL-6 level, and CD4^＋/CD8^＋ [ Conclusion ] There exists a correlation of AsAb content with chronic genital tract inflammation. QHM and YHP Ⅰ are effective for AII, and their therapeutic mechanism may be related with keeping the balance of Th/Ts and with clearing AsAb by regulating CD4^＋/CD8^＋ .