多囊卵巢综合征与CD8^＋CD28^＋／CD8^＋CD28^-T细胞平衡的关系

Role of CD8 ^＋ CD28^＋/CD8 ^＋ CD28 ^- T cells balance in patients with polycystic ovary syndrome

目的从内分泌及胰岛素抵抗的角度探讨CD8^＋CD28^＋及CD8^＋CD28^-T（杀伤性／抑制性）T细胞平衡与多囊卵巢综合征（PCOS）的关系。方法收集胰岛素抵抗（IR）与非抵抗（Non-IR）PCOS患者各25例，选取同龄段健康女性30例作为对照组，采用流式细胞术检测外周血CD8^＋CD28^＋及CD8^＋CD28^-T细胞及其胞内细胞因子γ干扰素（IFN-γ）及白细胞介素-4（IL-4）的百分含量；采用放射免疫法检测血清卵泡刺激素（FSH）、黄体生成素（LH）水平及胰岛素水平，并比较患者的胰岛素抵抗指数（HOMA-IR），同时分析以上几者的相关性。结果IR组CD8^＋CD28^＋T细胞、IFN-γ及胰岛素显著低于健康组及Non-IR组，但IR组CD8^＋CD28^-T细胞、IL-4及HOMA-IR显著高于另外两组，以上任意两组的差异均具有统计学意义（t=0．719～5．892，均P〈0．05）。3组的LH有组间差异（F=3．762，P=0．010），以IR患者最高，但IR与Non-IR组间无统计学差异（t=0．976，P=0．362）。相关性分析表明CD8^＋CD28^＋T细胞与CD8^＋CD28^-T细胞呈显著负相关（r=-0．816，P=0．000），CD8^＋CD28^-抑制性T细胞与LH及HOMA指数均呈正相关（r=0．701，r=0．719，均P〈0．05），但与血清胰岛素水平及均呈负相关性（r=-0．631，P=0．038）。结论PCOS患者的免疫平衡向CD8^＋CD28^-抑制T细胞倾斜，表现为过度抑制，该细胞数量的升高与内分泌紊乱及胰岛素抵抗密切相关。

Objective To investigate the correlation between the balance of CD8^＋ CD28 ^＋/CD8 ^＋ CD28^ - T （cytotoxicity/inbibition） cells and polycystic ovary syndrome （PCOS） from the view of endocrine and insulin resistance. Methods Twenty-five eases of PCOS of insulin resistance （IR） and another 25 cases of PCOS of non-resistance （Non-IR） were recruited. Thirty healthy women with same age segment were selected in control group. The percentage content of peripheral CD8 ^＋ CD28 ^＋ T and CD8 ^＋ CD28 ^- T cells and intracellular interferon- γ （IFN-γ） and interleukin-4 （IL-4） were detected with flow cytometry. Serum follicle-stimulating hormone （FSH）, luteinizing hormone （LH） and insulin levels were determined by radioimmunoassay. Then insulin resistance index （HOMA-IR） of patients was compared, and the correlation among them was analyzed. Results The CD8 ^＋ CD28 ^＋ T ceils, IFN-γ and insulin of IR group were significantly lower than those of healthy group and Non-IR group, but CD8 ^＋ CD28 - T ceils, IL-4 and HOMA-IR were significantly higher than the other two groups. The differences between any two groups were statistically significant （t =0.719 -5. 892, all P 〈0.05）. There were differences in LH among three groups （F = 3. 762, P = 0.010）. It was highest in patients with IR, but there was no statistical difference between IR group and Non-IR group （ t = 0. 976, P = 0. 362）. Correlation analysis showed a significant negative correlation between CD8 ^＋ CD28 ^＋ T and CD8 ^＋ CD28-T ceils （r = -0. 816, P = 0. 000）. CD8 ^＋ CD28^-T ceils were positively correlated with LH and HOMA-IR （r value was 0.701 and 0.719 , respectively, both P 〈 0.05 ）, but negatively correlated with insulin level （ r -- - 0.631, P = 0.038 ）. Conclusion The immune balance of patients of PCOS inclines towards CD8 ^＋ CD28^- T ceils, and manifests as excessive suppression. The increasing of CD8 ^＋ CD28^-T cells is closely related with endocrine disorders and IR.