复发性流产患者维生素D水平、甲状腺功能及调节性T细胞表达的相关性分析

Correlation analysis of serum vitamin D level,thyroid function and Treg cells in patients with recurrent spontaneous abortion

目的:探讨复发性流产患者维生素D水平与甲状腺功能、调节性T(Treg)细胞的相关性。方法:选取2020年4月至2021年10月在华中科技大学同济医学院附属湖北妇幼保健院就诊的复发性流产患者102例作为复发性流产组,正常早孕者40例作为对照组。检测两组孕妇的血清维生素D水平、游离甲状腺激素(FT4)、游离三碘甲状腺原氨酸(FT3)、促甲状腺激素(TSH)、抗甲状腺球蛋白抗体(TgAb)、抗甲状腺过氧化物酶抗体(TPOAb),采用流式细胞仪测定各组外周血中Treg细胞、Th17细胞及Treg/Th17比值,对比不同维生素D水平的复发性流产患者以上指标的差异。结果:复发性流产组患者血清维生素D水平、Treg细胞和Treg/Th17比值低于对照组,TSH、TgAb、TPOAb和Th17细胞明显高于对照组,差异有统计学意义(P<0.01),而FT3和FT4水平与对照组比较差异无统计学意义(P>0.05)。低维生素D水平复发性流产组患者外周血Treg细胞比例低于维生素D组,Th17细胞、TgAb和TPOAb水平高于维生素D组。复发性流产患者血清维生素D水平与Treg和Treg/Th17比值呈正相关(r=0.507、0.614,P<0.05),与Th17、TgAb、TPOAb存在负相关(r=-0.515、-0.473、-0.539,P<0.05)。结论:复发性流产的发生可能与维生素D不足、Treg/Th17失衡及甲状腺功能异常相关。

Objective:To explore the correlation analysis of serum vitamin D levels in patients with recur⁃rent spontaneous abortion(RSA)and thyroid function and Treg cells.Methods:From April 2020 to October 2021,102 patients with RSA were recruited as the RSA group,40 normal early pregnant women in Maternal and Child Hospital of Hubei Province,Tongji Medical College,Huazhong Univer⁃sity of Science and Technology during the same period were also involved as the control group.The levels of serum vitamin D,free thyroid hormone(FT4),free triiodothyronine(FT3),thyroid stimulat⁃ing hormone(TSH),anti⁃thyroglobulin antibody(TGAb),and anti⁃thyroid peroxidase antibody(TPOAb)were measured.Treg cells,Th17 cells,and Treg/Th17 ratio in peripheral blood were measured by flow cytometry.The above indexes in RSA patients with different vitamin D levels were compared.Results:The levels of serum vitamin D,Treg cells and Treg/Th17 ratio in the RSA group were lower than those in control group,and the levels of TSH,TGAb,TPOAb,and Th17 cells were significantly higher than those in control group(P<0.01),but there was no significant dif⁃ference in the levels of FT3 and FT4 between RSA group and control group(P>0.05).The propor⁃tion of peripheral blood Treg cells in low vitamin D RSA group was lower than that in normal vitamin D group,and the levels of Th17 cells,TGAb and TPOAb were higher than those in normal vitamin D group.The serum vitamin D level in RSA patients was positively correlated with Treg and Treg/Th17 ratio(r=0.507 and 0.614,respectively,P<0.05),and negatively correlated with Th17,TGAb,and TPOAb(r=-0.515,-0.473,and-0.539,respectively,P<0.05).Conclusion:The occurrence of RSA may be related to vitamin D insufficiency and Treg/Th17 imbalance and thy⁃roid dysfunction.