妊娠高血压综合征患者外周血中胎儿细胞的检测与免疫状况研究

The evaluation of the immune status and the detection of the fetal cells in peripheral blood of patients with pregnancy induced hypertension syndrome

目的研究孕妇外周血中胎儿细胞种类、数量及免疫状况与妊娠高血压综合征（PIH）的关系，探讨PIH的发病机制。方法（1）采用流式细胞术比较3种不同方法：CD71、HbF／i抗原（血红蛋白F／血型i抗原）和HbF／CA（血红蛋白F／碳酸酐酶）分别检测孕妇外周血中胎儿有核红细胞（tNRBCs）。（2）同时检测孕妇组和PIH组的免疫学指标：淋巴细胞亚群、细胞因子等。结果（1）3种方法CD71、HbWi抗原、HbF／CA检测胎儿红细胞PIH患者组[百分比中位数（95％可信上限）分别为6．56（11．37）％、0．09（0．16）％、0．6（0．11）％]与正常孕妇组[分别为1．58（3．35）％、0．04（0．08）％、0．02（0．06）％]差异均具有统计学意义（z值分别为：-5．31、-2．97、-4．13，P值均〈0．01）。（2）PIH组的淋巴细胞亚群和TNFα及IL-6，除CD8（30．2±7．1）％与正常孕妇组（31．0±7．1）％差异无统计学意义（P=0．620）外，CD3（76．4±8．5）％、CD4（42．6±6．4）％、CD4／CDB（1．5±0．4）％、CD19（10．5±3．9）％、CD16／CD56（12．2±7．7）％、TNF-α（1．4±0．6）μg/L及IL-6（89．6±12．9）μg/L和正常孕妇组[分别为CD3（70．4±8．3）％、CD4（35．3±6．9）％、CD4／CD8（1．2±0．4）％、CD19（8．2±2．8）％、CD16／CD56（20．5±8．9）％、TNF-α（0．5±0．2）μg／L及IL-6（22．0±5．7）μg/L]之间差异均具有统计学意义（P〈0．001）。结论孕妇外周血中tNRBCs的数量增多引起的免疫状况的改变均可能是PIH发生发展的重要因素。

Objective To investigate various types and quantities of fetal cells getting into peripheral blood of pregnant women and immune status related to pregnancy induced hypertension syndrome （PHI） and analyze the etiology of PIH. Methods （ 1 ） Three markers of fetal nucleated red blood ceils （fNRBCs） in normal pregnant women（ n = 43 ）and PIH patients （n = 39）were measured by flow cytometry： CD71, HbF/iAg and HbF/CA. （2） We detected the levels of sub-groups of lymphocytes and some plasma cytokines,such as TNF-α and IL-6. The blood samples were from normal pregnant subjects and patients of PHI. Results In the peripheral blood of patients of PIH and normal pregnant subjects, （ 1 ） The quantities of fetal cells using three different methods in PIH [ 6. 56 （ 11.37 ） % ,0. 09 （ 0. 16） % ,0. 06 （ 0. 11 ） % ] were significantly different from normal pregnant subjects [ 1.58 （ 3.35 ） % ,0. 04 （ 0. 08 ） % ,0. 02 （0. 06） % ], Z = - 5.31, - 2. 97, - 4. 13 respectively,P 〈 0. 01. （2） Except CD8, the levels of CD3 （76. 4± 8.5） %, CD4 （42.6±6.4）%, CD4/CD8 （1.5 ±0.4）%, CD19（10.5 ±3.9）%, CD16/CD56（12. 2±7.7）%, TNF-α （1.4 ±0. 6）μg/L and IL-6（89. 6 ±12. 9）μg/L in Pill were significantly different from normal pregnant subjects [CD3（70.4±8.3）%, CD4（35.3 ±6.9）%, CD4/CD8 （1.2 ±0.4）%, CD19 （8.2 ±2.8）%, CD16/CD36 （ 20. 5 ± 8. 9 ） %, TNF-α （ 0. 5 ± 0. 2 ） μg/L and IL-6 （ 22.0 ± 5.7 ） μg/L, respectively, P 〈 0. 001 ]. There were no significant differences observed in the level of CD8 （ P 〉 0. 05 ）. Conclusion The increment of fNRBCs getting into peripheral blood of pregnant women and associated immune status were implicated in the development of PIH.