协同刺激分子CD28、CTLA-4与子痫前期发病的关系

Relationship between costimulatory moleculars CD28,CTLA-4 and pathogenesis of preeclampsia

目的研究协同刺激分子CD28、CTLA-4在子痫前期发病中的作用。方法采集45例正常妊娠妇女(对照组)及63例子痫前期患者(子痫前期组:轻度31例,重度32例)外周血及子宫蜕膜,分离其内淋巴细胞,用流式细胞技术分别检测CD28、CTLA-4在CD3+T淋巴细胞上的表达率。结果与对照组相比,子痫前期组外周血CD3+T淋巴细胞上CD28的表达差异无统计学意义(P>0.05);子痫前期组蜕膜组织中CD28较低,差异有统计学意义(P<0.05);子痫前期组外周血与蜕膜CTLA-4分子表达均增加,且重度子痫前期组高于轻度子痫前期组(P<0.05);子痫前期组外周血与蜕膜CD28/CTLA-4比率均降低,且重度子痫前期组低于轻度子痫前期组,差异有统计学意义(P<0.05);外周血与子宫蜕膜的CD28、CTLA-4、CD28/CTLA-4均呈正相关。早发型、晚发型子痫前期两组CD28+、CTLA-4+、CD28+/CTLA-4的差异均无统计学意义(P>0.05)。结论子痫前期的发病可能是从蜕膜组织局部的免疫反应开始,协同刺激信号分子CD28/CTLA-4表达异常,高表达的CTLA-4可能是子痫前期发生的重要原因。

Objective To research the roles of costimulatory moleculars cluster of differentiation 28（ CD28）,cluster of differentiation28（ CTLA- 4） in pathogenesis of preeclampsia. Methods Peripheral blood and uterine decidua samples were collected from 45 healthy pregnant women（ control group） and 63 patients with preeclampsia（ preeclampsia group,31 patients with mild preeclampsia and 32 patients with severe preeclampsia were included）,the lymphocytes were isolated. Flow cytometry was used to detect the expression rates of CD28 and CTLA- 4 in CD3＋T lymphocyte. Results There was no statistically significant difference in the expression rate of CD28 in CD3＋T lymphocyte in peripheral blood between control group and preeclampsia group（ P〉0. 05）; the expression rate of CD28 in decidual tissue in preeclampsia group was lower than that in control group（ P〈0. 05）. In preeclampsia group,the expression rates of CTLA- 4 in peripheral blood and decidual tissue increased,especially in severe preeclampsia group（ P〈0. 05）; the ratio of CD28 / CTLA- 4 in peripheral blood and decidual tissue decreased,especially in severe preeclampsia group（ P〈0. 05）; there were positive correlations between CD28,CTLA-4,CD28 / CTLA- 4 ratio in peripheral blood and decidual tissue. There was no statistically significant difference in CD28＋,CTLA- 4＋,CD28＋/ CTLA- 4 ratio between early- onset preeclampsia group and late- onset preeclampsia group（ P〉0. 05）. Conclusion The onset of preeclampsia may initiate from local immunological reaction of decidua,the imbalance of CD28 / CTLA- 4 and high expression of CTLA-4 might lead to preeclampsia.