免疫球蛋白降低对复发性流产患者NK细胞的疗效评价

Efficacy of immunoglobulin on reducing recurrent spontaneous abortion in patients with elevated NK cells

目的比较静脉注射免疫球蛋白(IVIG)对不同水平自然杀伤细胞(NK)复发性流产患者的疗效。方法选择2011年10月至2015年12月在广州市增城区人民医院妇产科就诊的复发性流产(RSA)患者90例,按NK细胞是否正常分为NK细胞升高(试验组,56例)和NK细胞正常(对照组,34例),均给予低剂量IVIG,1次/月,疗程半年或至分娩结束,比较两组妊娠及不良反应情况。结果 90例患者均顺利接受IVIG治疗,试验组妊娠率(87.50%)、正常分娩率(71.43%)均高于对照组(32.35%和11.76%),组间比较差异有统计学意义(χ2值分别为28.95、30.14,均P<0.05);试验组和对照组各有早产儿3例和1例,剖宫产2例和1例,组间比较差异均无统计学意义(χ2值分别为0.29、0.03,均P>0.05);两组分别有部分患者出现输液反应、头痛和过敏等不良反应,无1例患者发生肝肾功能损害,两组不良反应发生率分别为10.71%和17.65%,组间比较差异无统计学意义(χ2=0.88,P=0.35)。结论低剂量IVIG能有效改善NK细胞上升RSA女性的妊娠及正常分娩率,NK细胞应该成为RSA患者的常规检查。

Objective To evaluate the efficacy of intravenous immunoglobulin（IVIG）on efficacy of recurrent spontaneous abortion（RSA）with different levels of NK cells.Methods From October 2011 to December 2015,90 cases of RSA visiting People＇s Hospital Zengcheng District were divided into NK cells elevated group（test group,n=56）and NK cells normal group（control group,n=34）according to NK cells level.Low-dose IVIG was administered once a month.Course was six months or lasted to birth.Pregnancy and adverse reactions were compared between two groups.Results All of 90 patients received IVIG treatment successfully.The pregnancy rate and normal delivery rate of test group（87.50%,71.43%）were higher than the control group（32.35%,11.76%）,and there were statistically significant differences between two groups（χ2 value was 28.95 and 30.14,respectively,both P0.05）.There were 3 cases and 1 case of preterm children,2 cases and 1 case of caesarean section in test and control group,respectively,and the differences were not significant（χ2 value was 0.29 and 0.03,respectively,both P0.05）.Some patients complained of infusion reactions,headache and allergies and other adverse reactions in two groups.No liver kidney dysfunction occurred.The incidence of adverse reactions in two groups was 10.71% and 17.65% without statistical significance（χ2=0.88,P=0.35）.Conclusion Low-dose IVIG can improve normal pregnancy and normal delivery rate of cases of RSA with elevated NK cells,and NK cells should become a routine examination in RSA patients.