淋巴细胞主动免疫治疗对反复胚胎种植失败患者的临床效果及T淋巴细胞因子水平变化的影响

Study on clinical efficacy of lymphocyte active immunotherapy in patients with repeated embryo implantation failure and level change of T-lymphocytes cytokines

目的探讨淋巴细胞主动免疫治疗(LIT)对反复胚胎种植失败(RIF)患者临床效果及T淋巴细胞因子水平变化的影响。方法选取2014-2016年在昆明医科大学第二附属医院生殖医学科接受体外受精与胚胎移植(IVF-ET)助孕的不明原因RIF患者214例为研究对象,根据是否接受LIT分为LIT组(97例)及对照组(117例),比较两组患者胚胎种植率、临床妊娠率及流产率。2016年5-12月接受LIT患者21例,测定治疗前后T淋巴细胞相关因子水平。结果 LIT组患者胚胎种植率、临床妊娠率明显高于对照组,差异有统计学意义(P<0.05),流产率明显低于对照组,但差异无统计学意义(P>0.05)。21例RIF患者LIT治疗后γ-干扰素(IFN-γ)、白细胞介素-17(IL-17)水平、IL-17/转化生长因子-β1(TGF-β1)比值较治疗前下降,差异有统计学意义(P<0.05),IL-10及TGF-β1水平较治疗前增高,但差异无统计学意义(P>0.05)。结论 LIT可以改善RIF患者再次IVF-ET的结局,其对Th1型细胞因子下调作用明显,对Th2型细胞因子调节作用不明显。

Objective To explore the clinical efficacy of lymphocyte active immunotherapy(LIT)in the patients with repeated embryo implantation failure(RIF)and the change of T lymphocyte cytokine levels.Methods Two hundreds and fourteen unknown RIF cases receiving in vitro fertilizatio and embryo transfer(IVF-ET)in this hospital during 2014-2016 served as the study subjects and were divided into LIT group(97 cases)and control group(117 cases)according to whether receiving LIT.The embryo implantation rate,clinical pregnancy rate and early abortion rate were compared between the two groups.Twenty-one cases received LIT from May to December 2016.The T lymphocyte related cytokine level was detected before and after the therapy.Results The embryo implantation rate and clinical pregnancy rate in the LIT group were significantly higher than those in the control group,and the difference was statistically significant(P<0.05),while the abortion rate was lower than that in the control group,but the difference between them had no statistical significance(P>0.05).The IL-17 and IFN-γlevels and IFN-γ/IL-10 ratio after treatment in 21 cases of RIF were decreased compared with before treatment(P<0.05),while the IL-10 and TGF-β1 levels were increased compared with before treatment,but the difference was not statistically significant(P>0.05).Conclusion LIT can improve the outcomes of RIF patients with IVF-ET once again,has obvious down-regulative effect on Th1 type cytokines and its regulative effect on Th2 type cytokines is unobvious.