未足月胎膜早破孕妇外周血CD4^+、CD8^+T淋巴细胞、NK细胞CD56水平及与绒毛膜羊膜炎的关系

Levels of T lymphocyte subsets CD4^+, CD8^+, CD56 in peripheral blood of pregnant women with preterm premature rupture of membranes and their relationships with chorioamnionitis

目的探讨未足月胎膜早破(PPROM)孕妇外周血T淋巴细胞亚群CD4^+、CD4/CD8、CD8^+及自然杀伤细胞(NK)CD56水平与绒毛膜羊膜炎(HCA)的关系。方法选取2018年1月至2019年1月在河北省儿童医院住院分娩的50例PPROM孕妇作为研究对象。将这50例孕妇设为研究组,另选取50例正常孕妇设为对照组。使用流式细胞仪检测外周血中T淋巴细胞亚群CD4^+、CD4/CD8、CD8^+及NK细胞CD56水平,并用MRFlow流式细胞分析软件自动行淋巴细胞亚群CD4^+、CD4、CD8、CD8^+及NK细胞CD56绝对计数。研究组孕妇于产后将胎盘、胎膜送病理科,根据是否感染HCA分为非HCA组21例和HCA组29例。采用ROC曲线分析孕妇外周血T淋巴细胞亚群CD4^+、CD4^+/CD8^+、CD8^+及NK细胞CD56水平对HCA的预测价值。结果研究组孕妇外周血T淋巴细胞亚群CD4^+、CD4/CD8及NK细胞CD56水平均低于对照组孕妇,差异具有统计学意义(P<0.05),CD8^+水平高于对照组孕妇,差异具有统计学意义(P<0.05)。研究组HCA孕妇外周血T淋巴细胞亚群CD4^+、CD4^+/CD8^+及NK细胞CD56水平均明显低于非HCA孕妇,差异具有统计学意义(P<0.05),CD8^+水平高于非HCA孕妇,差异具有统计学意义(P<0.05)。HCA重度组孕妇外周血T淋巴细胞亚群CD4^+、CD4^+/CD8^+及NK细胞CD56水平最低、CD8^+水平最高,中度组次之,HCA轻度组孕妇外周血T淋巴细胞亚群CD4^+、CD4/CD8及NK细胞CD56水平最高、CD8^+水平最低,两两比较差异均具有统计学意义(P<0.05)。外周血CD4^+、CD4^+/CD8^+、CD8^+及NK细胞CD56水平预测孕妇发生HCA的ROC曲线下面积分别为0.849、0.913、0.856、0.903,CD4^+/CD8^+诊断效能最佳,灵敏度为82.80%、特异度为90.50%。结论 PPROM孕妇外周血T淋巴细胞亚群CD4^+、CD4^+/CD8^+、CD8^+及NK细胞CD56水平与HCA发生、发展有关,及时检测上述指标有利于早期诊断HCA。

Objective To investigate the relationships between the levels of T lymphocyte subsets CD4^+, CD4/CD8, CD8^+ and natural killer cell(NK) CD56 in peripheral blood of pregnant women with premature rupture of membranes(PPROM) and chorioamnionitis(HCA). Methods 50 pregnant women with PPROM and 50 normal pregnant women in Hebei Children's Hospital from January 2018 to January 2019 were selected as the study group and the control group respectively.The levels of T lymphocyte subsets CD4^+, CD4^+/CD8^+, CD8^+ and NK cell CD56 in peripheral blood were measured by flow cytometry and the absolute counts of lymphocyte subsets CD4^+, CD4, CD8^+, CD56 of lymphocyte subsets were automatically performed by MRFlow flow cytometry software.The placenta and membranes of pregnant women in the study group were sent to the Pathology Department after delivery and according to whether they were infected with HCA, they were divided into non-HCA group(21 cases) and HCA group(29 cases).The predictive values of T lymphocyte subsets CD4^+, CD4^+/CD8^+, CD8^+ and NK cell CD56 in pregnant women were analyzed by Receiver Operating Characteristic(ROC) curve. Results The levels of T lymphocyte subsets CD4^+, CD4^+/CD8^+ and the level of NK cell CD56 in peripheral blood of pregnant women in the study group were significantly lower than those in the control group, with statistically significant differences(P<0.05), and the level of CD8^+ was significantly higher than that in the control group, with statistically significant differences(P<0.05).The levels of T lymphocyte subsets CD4^+, CD4^+/CD8^+ and the level of NK cell CD56 in peripheral blood of HCA pregnant women in the study group were significantly lower than those of non-HCA pregnant women, with statistically significant differences(P<0.05), and the level of CD8^+ was significantly higher than that of non-HCA pregnant women, with statistically significant differences(P<0.05).The levels of T lymphocyte subsets CD4^+, CD4^+/CD8^+ and the level of NK cell CD56 in peripheral blood were the lowest and the level of CD8^+ were the highest in severe HCA group, followed by moderate HCA group, and the levels of T lymphocyte subsets CD4^+, CD4^+/CD8^+ and the level of NK cell CD56 in peripheral blood were the lowest and the level of CD8^+ were the highest in mild HCA group, with significant differences between groups(P<0.05).The areas under the curve of CD4^+, CD4^+/CD8^+, CD8^+ and NK cell CD56 levels in peripheral blood for predicting HCA in pregnant women were 0.849, 0.913, 0.856 and 0.903, respectively.CD4^+/CD8^+ had the best diagnostic efficacy, whose sensitivity was 82.80% and specificity was 90.50%. Conclusions The levels of T lymphocyte subsets CD4^+, CD4^+/CD8^+, CD8^+ and the level of NK cell CD56 in peripheral blood of pregnant women with PPROM are related to the occurrence and development of HCA.Timely detection of these indicators is helpful for early diagnosis of HCA.