醋酸泼尼松治疗URSA对临床结局及NK细胞表型的影响

Effects of prednisone therapy on the clinical outcomes and phenotypes of natural killer cells in patients with URSA

目的分析醋酸泼尼松治疗原因不明复发性自然流产（URSA）的临床结局（持续妊娠〉12周）及治疗前、后NK细胞CD56、CD16变化。方法选择URSA患者160例,分为2组,每组80例。试验组给予醋酸泼尼松及阿司匹林治疗;对照组给予安慰剂及阿司匹林治疗;治疗周期始于孕4~5周止于孕12周,如治疗期间流产即停药。采用流式细胞仪测定治疗前、后外周血NK细胞CD56、CD16百分率。结果试验组持续妊娠〉12周百分率高于对照组（P=0.00）;试验组治疗后CD16较治疗前降低（P=0.00）;对照组治疗前、后CD16差异无统计学意义（P=0.79）;试验组、对照组治疗前、后CD56差异无统计学意义（试验组P=0.09,对照组P=0.12）。结论醋酸泼尼松改善URSA患者的临床结局可能与CD16降低、抑制细胞毒性作用有关。

Objective To analyze the clinical outcomes（ ongoing pregnancy 12 weeks） and changes of natural killer（ NK） cells CD56 and CD16 before and after prednisone treatment in patients with URSA（ unexplained recurrent spontaneous abortion,URSA）. Methods A total of 160 URSA patients were divided into two groups： experimental group（ receiving prednisone and aspirin therapy,n = 80）,and control group（ receiving placebo and aspirin therapy,n = 80）.The therapy started from 4-5 weeks to 12 weeks of gestation,and stopped if abortion occurred. The percentages of CD56 and CD16 were measured by flowcytometry before and after treatment. Results The percentage of ongoing pregnancy 12 weeks was significantly higher in the experimental group than in the control group（ P = 0. 00）. The level of CD16 markedly dropped after treatment in the experimental group（ P = 0. 00）,while it remained unchanged in the control group（ P = 0. 79）. There was no statistical difference in the level of CD56 before and after treatment between the two groups（ experimental group P = 0. 09,control group P = 0. 12）. Conclusion Prednisone can improve the clinical outcome in patients with URSA,which may be related to the reduction of CD16 and inhibition of cell toxicity.