免疫疗法在反复自然流产患者中的临床效果及对T淋巴细胞水平的影响研究

Clinical effect of immunotherapy on patients with recurrent spontaneous abortion and its effect on level of T lymphocytes

目的:探讨免疫疗法在反复自然流产患者中的临床效果及对T淋巴细胞水平的影响。方法:选择2015年1月~2017年5月以反复自然流产收治的患者70例作为对象,根据治疗方法不同分为对照组(n=35)和观察组(n=35)。对照组采用黄体酮联合口服药物治疗,观察组在对照组基础上联合大剂量免疫球蛋白治疗,两组均进行24周治疗,治疗完毕后对患者效果进行评估。采用免疫荧光法测定两组治疗前、治疗后24周孕酮(P)、雌二醇(E2)和人绒毛膜促性腺激素(β-hCG)水平;采用流式细胞仪测定两组治疗前、治疗后24周CD3^+、CD4^+、CD8^+及CD4^+/CD8^+水平;记录并统计两组活产数、流产数、皮疹、轻微刺痛、妊娠期高血压疾病发生率;记录并统计两组流产孕周、新生儿体重及新生儿1min、5minApgar评分,比较两组临床疗效及对T淋巴细胞水平的影响。结果:治疗前两组P、E2及β-hCG水平差异无统计学意义(P>0.05);观察组治疗后24周P、E2及β-hCG水平均高于对照组(P<0.05);观察组治疗后24周CD3^+、CD4^+及CD4^+/CD8^+水平均高于对照组(P<0.05);观察组治疗后24周CD8^+低于对照组(P<0.05);观察组治疗后24周活产数高于对照组(P<0.05);观察组治疗后24周流产数低于对照组(P<0.05);观察组与对照组皮疹、轻微刺痛、妊娠期高血压疾病比较差异无统计学意义(P>0.05);观察组与对照组治疗后流产孕周、新生儿体重及新生儿1min、5minApgar评分比较差异无统计学意义(P>0.05)。结论:免疫疗法用于反复自然流产患者中有助于改善雌孕激素水平,能提高T淋巴细胞水平,能获得较好的妊娠结局,值得推广应用。

Objective: To investigate the clinical effect of immunotherapy on patients with recurrent spontaneous abortion and its effect on the level of T lymphocytes. Methods: A total of 70 patients who had undergone recurrent spontaneous abortion from January 2015 to May 2017 were selected as subjects.According to the treatment method,they were divided into control group ( n =35) and observation group ( n =35).The control group was treated with progesterone combined with oral medication.The observation group was treated with high-dose immunoglobulin on the basis of the control group.Both groups were treated for 24 weeks.The effect of the patient was evaluated after the treatment.The levels of progesterone (P),estradiol (E2) and human chorionic gonadotropin (β-hCG) were measured by immunofluorescence method before and 24 weeks after.The two groups were treated by flow cytometry.The levels of CD3 +,CD4 +,CD8 + and CD4 +/CD8 + were measured by flow cytometry before and 24 weeks after treatment.The number of live births and abortions were recorded and counted.The incidence of rash,mild tingling,and hypertensive disorder complicating pregnancy;recorded and counted two groups of abortion gestational weeks,neonatal weight,and neonatal 1 min,5 min Apgar scores,comparing of the clinical efficacy and its effect on T lymphocyte levels. Results: There were no significant differences in the levels of P,E2 and β-hCG between the two groups ( P >0.05).Aftere observation group received 24 weeks the E2 and β-hCG levels were higher than the control group ( P <0.05).The levels of CD3 +,CD4 +and CD4 +/CD8 + in the observation group were higher than those in the control group ( P <0.05).The CD8 + in the observation group was lower than that in the control group at 24 weeks after treatment ( P <0.05).The number of live births in the observation group at 24 weeks after treatment was higher than the control group ( P <0.05).The number of abortions in the observation group 24 weeks after treatment was lower than that in the control group ( P <0.05).There was no statistical difference in rash,slight tingling,and hypertensive disorders during pregnancy between the observation group and the control group( P >0.05).There was no significant difference in the Apgar score between the observation group and the control group after abortion,gestational age,neonatal weight,and neonatal 1 min and 5 min Apgar scores ( P >0.05). Conclusion: Immunotherapy can improve the level of estrogen and progesterone in patients with recurrent spontaneous abortion,increase the level of T-lymphocytes,and obtain good pregnancy outcomes.It is worthy of popularization and application.