葡萄胎患者外周血CD8^+T细胞平衡特点与临床意义

Balance of CD8^+CD28^+/CD8^+CD28^- T Cell and Its Clinical Significance for Patients with Hydatidiform Mole

目的探讨CD8^+CD28^+/CD8^+CD28^-T细胞平衡(Tc1/Tc2)在葡萄胎发病中的作用及其临床意义。方法收集葡萄胎患者28例,选择子宫肌瘤患者及健康女性各20作为对照。采用流式细胞术检测CD8^+CD28^+及CD8^+CD28^-T细胞及其胞内TNF-α及IFN-γ的百分含量。给予葡萄胎患者口服米非司酮并复查以上指标。结果 1)葡萄胎患者CD8^+CD28^+T细胞含量明显高于子宫肌瘤组及健康组(P<0.05);而CD8^+CD28^-T细胞及CD8^+CD28^+/CD8^+CD28^-T细胞比值明显低于子宫肌瘤组及健康组(P<0.05);葡萄胎患者IFN-γ含量明显低于子宫肌瘤组及健康组,但葡萄胎及子宫肌瘤患者TNF-α含量均高于健康人(P<0.05)。2)服用米非司酮后,两组患者CD8^+CD28^-T细胞均不同程度升高(P<0.05),而CD8^+CD28^+T细胞以及以上比值不同程度下降(P<0.05),且均以部分性葡萄胎患者的变化幅度较完全性葡萄胎显著(P<0.05)。治疗前与治疗后部分性葡萄胎患者IFN-γ均高于完全性葡萄胎患者(P<0.05)。结论 CD8^+CD28^+/CD8^+CD28^-T细胞失衡是葡萄胎的一个重要免疫学特征;米非司酮可有效纠正该平衡,可能是治疗葡萄胎的一个新的免疫机制。

Objective To investigate the CD8＋CD28＋/CD8＋CD28 T cell balance （Tc1/Tc2） in the role of hydatidiform mole and its clinical significance. Methods 28 cases with hydatidiform mole were collected, and 20 cases with uterine fibroids and 20 healthy women as controls. Flow cytometry was used to detect CD8＋CD28＋ and CD8＋CD28 T cells and the intracellular TNF-a and IFN-y in percentage content. Mifepristone was given to patients with mole to review the above indicators. Results 1） Patients with mole had significantly higher content of CD8＋CD28＋ cell than the uterine myoma group and healthy group （P〈0.05）; CD8＋CD28- T cell and CD8＋CD28＋/CD8＋CD28- T cell ratio was significantly lower than that of uterine fibroids and healthy group （P 〈0.05）; patients with mole had significantly lower IFN-y than the uterine myoma group and the healthy group, but the mole and uterine fibroids of TNF-a were higher than healthy women （P〈0.05）. 2） After taking mifepristone, the two groups of patients increased CD8＋CD28- T cells to varying degrees （P〈0.05）, while CD8＋CD28＋ T cells as well as the above ratio decreased to varying degrees （P〈0.05）, and patients with partial mole changed more significantly （P〈0.05） than those with complete mole. Before and after treatment, patients with partial mole had higher IFN-y than those with complete mole （P 〈0.05）. Conclusion Imbalance of CD8＋CD28＋/CD8＋CD28- T cell is an important immunological feature of hydatidiform mole; Mifepristone can effectively correct the balance, which may be a new immune mechanism in the treatment of hydatidiform mole.