T淋巴细胞亚群与多囊卵巢综合征不孕患者临床特征的关系及对其治疗预后的影响

The relationship between T lymphocyte subsets and clinical characteristics of infertile patients with polycystic ovarian syndrome and its effect on treatment prognosis

目的探讨T淋巴细胞亚群与多囊卵巢综合征(polycystic ovarian syndrome,PCOS)不孕患者临床特征的关系及对其生育预后的影响。方法选取2020年1月至2021年6月在海南医学院第二附属医院就诊的PCOS不孕患者80例为观察组,选取同期健康体检的妇女80例为对照组,比较两组患者外周血CD3^(+)T细胞、CD4^(+)T细胞、CD4^(+)T/CD8^(+)T以及CD8^(+)T细胞表达水平,按不同治疗预后将PCOS不孕患者分为妊娠组66例(82.5%)和未妊娠组14例(17.5%),重点分析T淋巴细胞亚群与PCOS不孕患者治疗预后的相关性,绘制外周血T淋巴细胞亚群预测PCOS不孕患者治疗预后的ROC曲线和决策曲线,进一步验证其预测效能和净收益率,Pearson相关性分析探讨外周血T淋巴细胞亚群与其临床特征的相关性。结果观察组外周血CD3^(+)T及CD8^(+)T细胞明显低于对照组(P<0.05),CD4^(+)T及CD4^(+)T/CD8^(+)T明显高于对照组(P<0.05)。未妊娠组外周血T、CD4^(+)T细胞以及CD4^(+)T/CD8^(+)T表达水平明显高于妊娠组(P<0.05),CD8^(+)T细胞明显低于妊娠组(P<0.05)。多因素Logistic回归分析结果显示,CD4^(+)T细胞以及CD4^(+)T/CD8^(+)T为影响PCOS不孕患者治疗预后的独立预测因素。ROC分析显示,CD4^(+)T细胞预测PCOS不孕患者治疗预后的曲线下面积(AUC)为0.812(0.787-0.876),最佳诊断截点为0.363,CD4^(+)T/CD8^(+)T的AUC为0.836(0.778-0.894),最佳诊断截点为1.400,联合预测的AUC为0.952(0.887~0.991)。决策曲线分析显示:CD4^(+)T细胞、CD4^(+)T/CD8^(+)T以及联合预测PCOS不孕患者治疗预后均具有良好的净收益率;相关性分析显示:PCOS不孕患者外周血CD4^(+)T细胞与总睾酮(T)、空腹血糖、空腹胰岛素、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、甘油三酯(TG)呈明显正相关(P<0.05),而CD4^(+)T/CD8^(+)T与T、空腹血糖、空腹胰岛素、HOMA-IR、TC、TG以及低密度脂蛋白(LDL)呈明显正相关(P<0.05)。结论外周血CD4^(+)T细胞以及CD4^(+)T/CD8^(+)T表达水平越高,PCOS不孕患者治疗预后越差,治疗后不孕的风险越高。

Objective To investigate the relationship between T lymphocyte subsets and clinical characteristics of infertile patients with polycystic ovarian syndrome(PCOS),and its effect on the fertility prognosis of patients.Methods 80 PCOS infertile patients who visited Second Affiliated Hospital of Hainan Medical University from January 2020 to June 2021 were selected as the observation group,and 80 women who underwent physical examination at the same time were selected as the control group.The expression levels of CD3^(+)T cells,CD4^(+)T cells,CD4^(+)T/CD8^(+)T and CD8^(+)T cells in the peripheral blood of patients between the two groups were compared.PCOS infertile patients were divided into pregnancy group(66 cases,82.5%)and non-pregnancy group(14 cases,17.5%)according to different treatment prognosis.The correlation between T lymphocyte subsets and the treatment prognosis of PCOS infertile patients was analyzed.ROC curve and decision curve of peripheral blood T lymphocyte subsets in predicting the treatment prognosis of PCOS infertile patients were drawn to further verify their predictive efficacy and net rate of return.Pearson correlation analysis was performed to explore the correlation between peripheral blood T lymphocyte subsets and the clinical characteristics of patients.Results The peripheral blood CD3^(+)T cells and CD8^(+)T cells of patients in the observation group were significantly lower than those in the control group(P<0.05),while CD4^(+)T cells and CD4^(+)T/CD8^(+)T of patients were significantly higher than those in the control group(P<0.05).The level of T,CD4^(+)T cells and CD4^(+)T/CD8^(+)T expression in peripheral blood of patients in the non-pregnancy group was significantly higher than those in the pregnancy group(P<0.05),and the level of CD8^(+)T cells was significantly lower than those in the pregnancy group(P<0.05).Multivariate logistic regression analysis showed that CD4^(+)T cells and CD4^(+)T/CD8^(+)T were independent predictors of treatment prognosis of PCOS infertile patients.ROC analysis showed that the area under the curve(AUC)of CD4^(+)T cells predicting treatment prognosis of PCOS infertile patients was 0.812(0.787-0.876),the best diagnostic cutoff point was 0.363,the AUC of CD4^(+)T/CD8^(+)T was 0.836(0.778-0.894),the best diagnostic cutoff point was 1.400,and the AUC jointly predicted was 0.952(0.887-0.991).Decision curve analysis showed that CD4^(+)T cells,CD4^(+)T/CD8^(+)T and combined prediction of the prognosis of PCOS infertile patients had a good net rate of return.Correlation analysis showed that CD4^(+)T cells in peripheral blood of PCOS infertile patients were significantly positively correlated with total testosterone(T),fasting glucose,fasting insulin,insulin resistance index(HOMA-IR),total cholesterol(TC),and triglyceride(TG)(P<0.05),while CD4^(+)T/CD8^(+)T was significantly positively correlated with T,fasting glucose,fasting insulin,HOMA-IR,TC,TG and low density lipoprotein(LDL)(P<0.05).Conclusion The higher the expression level of CD4^(+)T cells and CD4^(+)T/CD8^(+)T expression in peripheral blood,the worse the prognosis of PCOS infertile patients and the higher the risk of infertility after treatment.