子痫前期患者pDC、Th22细胞比例失调与疾病发生发展的关系

Relationship between the disproportion of pDC and Th22 cells and the development of preeclampsia

目的探讨浆细胞样树突细胞(plasmacytoid dendritic cells,pDC)、辅助性T细胞(T-helper cell,Th)亚群T22细胞比例失调在子痫前期患者免疫致病及疾病进展中的作用。方法前瞻性纳入上海交通大学医学院附属第九人民医院于2019年4月至2021年12月收治的160例孕晚期子痫前期患者作为研究对象(子痫前期组),另择取同期于该院行常规产检的健康产妇160例作为健康对照组,检测并比较两组pDC、Th22细胞水平及其细胞因子水平。而后参照相关标准将子痫前期孕产妇再次分为轻度组(n=94)与重度组(n=66),采用受试者工作特征(receiver operating characteristic,ROC)曲线分别分析检验pDC、Th22细胞比例失衡在孕晚期子痫前期发生和进展中的诊断价值。结果子痫前期组孕妇Th22、白细胞介素(interleukin,IL)-22水平均明显高于健康对照组,pDC水平低于健康对照组,数据差异有统计学意义[(1.25±0.87)%比(0.63±0.28)%,(281.63±14.19)pg/mL比(204.18±11.13)pg/mL,(0.14±0.11)%比(0.23±0.14)%,t值分别为8.58、54.32、6.39,P值均<0.05)。重度子痫前期孕妇Th22、IL-22水平明显高于轻度组,pDC水平较轻度组偏低,数据差异有统计学意义[(1.48±0.71)%比(1.03±0.39)%,(296.68±12.15)pg/mL比(271.18±10.46)pg/mL,(0.06±0.01)%比(0.18±0.06)%,t值分别为5.14、14.20、16.08,P值均<0.05)。ROC曲线分析结果显示,Th22诊断孕晚期发生子痫前期的曲线下面积(area under curve,AUC)为0.710,最佳截断值为0.382%;IL-22的AUC为0.916,最佳截断值为196.164 pg/mL;pDC的AUC为0.866,截断值为0.138%。检测Th22、IL-22及pDC水平对孕晚期重度子痫前期的诊断AUC分别为0.854、0.896和0.784,最佳截断值分别为0.773%、2.275 pg/mL、0.082%。结论孕晚期子痫前期的发生可能与免疫失衡相关,监测孕产妇孕晚期外周血Th22、IL-22及pDC水平的变化对临床早期诊断子痫前期和评估子痫前期严重程度提供理论依据。

Objective To explore the role of the imbalance of plasmacytoid dendritic cells(pDC)and T-helper cell(Th)subset Th22 cells in immunopathogenesis and disease progression of preeclampsia patients.Methods A total of 160 patients with pre-eclampsia in late pregnancy who were admitted to Ninth People's Hospital Affiliated to the School of Medicine of Shanghai Jiaotong University from April 2019 to December 2021 were prospectively included as the research subjects(pre-eclampsia group),and another 160 healthy parturients who underwent routine antenatal examination at the same period in our hospital were selected as the healthy control group.The levels of pDC and Th22 cells as well as their cytokine levels were detected and compared between the two groups.Then according to the relevant standards,the pregnant women with pre-eclampsia were divided into mild group(n=94)and severe group(n=66)again.The diagnostic value of the imbalance of pDC and Th22 cells in the occurrence and progression of preeclampsia in the third trimester was analyzed and tested by receiver operating curve(ROC).Results Th22 and interleukin-22(IL-22)levels were significantly higher and pDC levels were lower in pre-eclampsia group than in healthy control group,and the data were significantly different[(1.25±0.87)%vs(0.63±0.28)%,(281.63±14.19)pg/mL vs(204.18±11.13)pg/mL,(0.14±0.11)%vs(0.23±0.14)%,t values were 8.58,54.32,6.39,all P values<0.05).Th22 and IL-22 levels were significantly higher and pDC levels were lower in severe group than in the mild group,and the data were significantly different[(1.48±0.71)%vs(1.03±0.39)%,(296.68±12.15)pg/mL vs(271.18±10.46)pg/mL,(0.06±0.01)%vs(0.18±0.06)%,t values were 5.14,14.20,16.08,all P values<0.05).ROC curve analysis showed that the area under curve(AUC)of Th22 in the diagnosis of preeclampsia in the third trimester was 0.710,and the best cut-off value was 0.382%;The AUC of IL-22 was 0.916 and the best cut-off value was 196.164 pg/mL;The AUC of pDC was 0.866 and the cut-off value was 0.138%.The AUC of Th22,IL-22 and PDC in the diagnosis of severe preeclampsia in the third trimester were 0.854,0.896 and 0.784 respectively,and the best cut-off values were 0.773%,2.275 pg/mL and 0.082%respectively.Conclusion The occurrence of preeclampsia in the third trimester of pregnancy may be related to immune imbalance.Monitoring the changes of Th22,IL-22 and pDC levels in maternal peripheral blood in the third trimester of pregnancy provides a theoretical basis for early clinical diagnosis of preeclampsia and evaluation of the severity of preeclampsia.