早期稽留流产患者免疫机制的研究

Study on mechanism of immunoregulatory role in the pathogenesis of pregnancy induced missed abortion

目的:探讨T细胞表型及Th1/Th2功能亚群在早期稽留流产发病中的免疫机制。方法:选取14例早期稽留流产患者(妊娠8～10周),采用血液自动分析仪检测其外周血中淋巴细胞和粒细胞百分率,采用流式细胞仪检测其外周血中T淋巴细胞及其亚群的百分率,用酶联免疫吸附法测定其血清中细胞因子干扰素-γ(Interferon-γ,IFN-γ)和白介素-4(Inter-leukin-4,IL-4)的浓度。同时选取18例正常妊娠早期妇女(妊娠8～10周)检测上述各项指标作为对照。结果:①早期稽留流产患者外周血中淋巴细胞比率29.77±4.37,明显高于对照组的23.4±5.96(P<0.05);粒细胞比率为60.09±4.58,明显低于对照组的67.76±7.31(P<0.05)。②早期稽留流产患者外周血中CD3+细胞和CD4+细胞的百分率以及CD4+/CD8+的比值分别为66.76±8.76、41.01±8.47、1.83±0.50,均显著高于正常妊娠早期妇女的56.72±10.86、31.22±7.70、1.20±0.42(P均<0.05);CD8+细胞的百分率为25.05±5.87,与对照组的27.35±6.28比较,无显著差异。③早期稽留流产患者血清中IFN-γ浓度为28.96±10.76ng/L,明显高于对照组18.11±7.08ng/L(P<0.01);IL-4为13.16±8.37ng/L,显著低于对照组的25.91±15.96ng/L(P<0.05)。结论:稽留流产的发生可能与CD4+/CD8+T细胞比例失调,以及Th1/Th2功能亚群向Th1偏移有关。

Objective： To investigate the mechanism of immunoreguatory role of T cell phenotypic subpopulation and Th1/Th2 functional subset in the pathogenesis of pregnancy induced missed abortion. Methods： Early missed abortion （8-10 weeks of gestation） of 14 and early pregnancy of 18 （control） were used in this present study. The lymphocyte and granulocyte of percentage in leucocytes of peripheral blood were detected by an automatic blood corpuscle counter. The flow cytometry was employed to measured T lymphocytes and their subpopulation in the peripheral blood.The levels of interleukin-4 （IL-4） and interforn-γ （IFN-γ） in the serum were measured by enzyme-linked immunosorbant assay （ELISA） . Results：①Compared with control group, the lymphocyte percentage in leucocytes of peripheral blood was notably increased （29.77±4.37 VS 23.4±5.96 P=0.020） , and the rate of granulocyte was remarkably decreased in the patients with missed abortion （60.09±4.58 VS 67.76±7.31 P=0.011）.②The percentage of CD3＋T cells and CD4^＋ T cells and the value CD4^＋/CD8^＋ in the peripheral blood were remarkably increased in patients with missed abortion compared with those in early normal pregnant women （66.76±8.76 VS 56.72±10.86 and 41.01±8.47 VS 31.22±7. 70 and 1.83±0. 50 VS 1.20±0. 42, respectively） There was no marked difference of CD8^＋ cells between them （25.05±5.87 VS 27.35±6.28）.③The concentration of IFN-γ in serum from the early missed abortion was remarkably increased when compared with that from the early pregnant women （28. 96±10. 76ng/L VS 18. 11±7. 08 ng/L P=0.0052）, In addition, there was dramatic lower the level of IL-4 in the early missed pregnancy than in the control （13.16±8.37ng/L VS 25.91±15.96ng/L P=0. 0317） . Conclusion： The occurrence of missed abortion may be associated with disorder of CD4^＋/CD8^＋ ratio, as well as of shift Th1/Th2 functional subset toward Th1.