粒细胞集落刺激因子治疗复发性流产的临床研究

Clinical effects of G-CSF in treatment of recurrent spontaneous abortion

目的观察粒细胞集落刺激因子(granulocyte-colony stimulating factor,G-CSF)治疗复发性流产(recurrent spontaneous abortion,RSA)的临床效果及可能机制。方法选择2018年2月至2020年5月就诊的并接受保胎治疗的120例RSA患者病历资料进行回顾分析,其中接受G-CSF治疗患者80例(G-CSF组),未接受G-CSF治疗患者40例(对照组),对比2组患者治疗前及妊娠10周时外周血Th1/Th2各型细胞因子浓度、子宫动脉阻力及妊娠结局。结果2组患者治疗前外周血白介素-2(interleukin-2,IL-2)、白介素-4(interleukin-4,IL-4)、白介素-6(interleukin-6,IL-6)、白介素-10(interleukin-10,IL-10)、肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、γ-干扰素(interferon-γ,INF-γ)浓度差异无统计学意义(P>0.05),G-CSF组孕10周时外周血IL-4、IL-6、IL-10浓度较治疗前明显上升,治疗前后差异有统计学意义(P<0.05),且高于对照组(P<0.05);对照组治疗前后外周血Th1/Th2各型细胞因子浓度差异无统计学意义(P>0.05);2组治疗前左侧、右侧及双侧子宫动脉血流收缩期、舒张末期峰值流速计算得S/D比值差异无统计学意义(P>0.05),G-CSF组孕10周时左侧、右侧及双侧子宫动脉计算所得S/D比值较治疗前明显下降,差异有统计学意义(P<0.05);对照组治疗前后左侧、右侧及双侧子宫动脉计算得S/D比值差异无统计学意义(P>0.05);G-CSF组孕10周时左侧、右侧及双侧子宫动脉计算所得S/D比值均低于对照组,差异均有统计学意义(P<0.05);G-CSF组患者发生再次流产率低于对照组(χ^(2)=5.326,P=0.0210)。结论G-CSF可增加RSA患者外周血Th2型细胞因子,降低子宫动脉阻力,提高RSA患者妊娠率。

Objective To investigate the clinical effects and possible action mechanism of granulocyte-colony stimulating factor(G-CSF)in treatment of recurrent spontaneous abortion(RSA).Methods A total of 120 patients with RSA who were admitted and underwent fetus protection treatment in our hospital from February 2018 to May 2020 were enrolled in the study,who were divided into G-CSF group(n=80)and control group withou treatment by G-CSF(n=40).The levels of peripheral blood Th1/Th2 and the other cytokines,the uterine artery resistance before treatment and at 10 weeks after pregnancy were observed and compared between the two groups.Results Before treatment there were no significant differences in the levels of IL-2,IL-4,IL-6,IL-10,TNF-α,and INF-γbetween the two groups(P>0.05).The levels of IL-4,IL-6,and IL-10 at 10 weeks after pregnancy in G-CSF group were significantly increased(P<0.05),moreover,which were significantly higher than those in control group(P<0.05).Before treatment there were no significant differences in S/D values of the left,right,and bilateral uterine artery between the two groups(P>0.05),however,which at 10 weeks after pregnancy in G-CSF group were significantly decreased(P<0.05),moreover,which in G-CSF group were significantly lower than those in control group(P<0.05).Conclusion G-CSF can increase the the levels of peripheral blood Th2 cytokine in patients with RSA,reduce the uterine artery resistance,and improve the pregnancy rate.