外周血免疫细胞群检测在不明原因复发性流产诊疗中的临床意义

Clinical Significance of Peripheral Blood Immune Cell Population Detection in Diagnosis and Treatment of Unexplained Recurrent Spontaneous Abortion

目的:检测外周血各类免疫细胞的表达水平,探讨其与不明原因复发性流产(URSA)的关系及临床诊疗意义。方法:选取2020年1月至2022年9月于河北省生殖健康医院就诊的351例URSA患者为URSA组,选取同期体检的既往正常分娩1胎且无不良孕产史的30例健康女性样本为对照组。检测并比较两组黄体中期外周血不同免疫细胞亚群的水平差异,采用受试者工作特征(ROC)曲线分析辅助URSA诊疗的免疫细胞水平最佳截断值,并采用多因素Logistic回归分析影响URSA发生的相关因素。结果:URSA组外周血中CD3^(+)CD8^(+)细胞数量和百分比低于对照组,自然杀伤(NK)细胞百分比高于对照组,差异有统计学意义(P<0.05),同时多因素Logistic回归分析发现黄体中期外周血CD3^(+)CD8^(+)细胞的增加是URSA的保护性因素(OR<1,P<0.05)。ROC曲线分析发现,CD3^(+)CD8^(+)细胞数量702.82个/l,CD3^(+)CD8^(+)细胞百分比28.39%和NK细胞百分比12.33%为辅助URSA诊断的免疫细胞水平最佳截断值。使用最佳截断值将连续变量转换为二分类变量后,多因素Logistic回归分析发现CD3^(+)CD8^(+)细胞数量<702.82个/μl、NK细胞百分比>12.33%是影响URSA发生的独立危险因素(OR>1,P<0.05)。结论:黄体中期外周血CD3^(+)CD8^(+)细胞的减少与URSA发生密切相关。CD3^(+)CD8^(+)细胞数量(702.82个/μl)和NK细胞百分比(12.33%)可作为诊断URSA的参考值。

Objective:To detect the expression levels of various immune cells in peripheral blood,and to explore their relationship with unexplained recurrent spontaneous abortion(URSA)and its clinical significance in diagnosis and treatment.Methods:A total of 351 patients with URSA who visited Hebei Reproductive Health Hospital between January 2020 and September 2022 were enrolled as the URSA group,while a control group comprising 30 healthy women who had experienced uncomplicated term delivery once and had no history of adverse pregnancy outcomes during the same period was selected.The levels of various immune cell subsets in peripheral blood during the luteal phase were measured and compared between the two groups.Receiver operating characteristic(ROC)curve analysis was performed to determine the optimal cutoff values of immune cell levels that could assist in URSA diagnosis and treatment,while logistic regression analysis was conducted to identify factors influencing URSA occurrence.Results:The number and percentage of CD3^(+)CD8^(+)cells in the peripheral blood of the URSA group were significantly lower compared to those in the control group(P<0.05).Conversely,the percentage of NK cells was significantly higher in the URSA group than in the control group(P<0.05).Logistic regression analysis revealed that the increase in CD3^(+)CD8^(+)cell count in peripheral blood during the luteal phase was a protective factor of URSA(OR<1,P<0.05).ROC curve analysis determined optimal cutoff values for immune cell levels to assist in the diagnosing and treating URSA:702.82 cells/μl for CD3^(+)CD8^(+)cell count,28.39%for CD3^(+)CD8^(+)cell percentage,and 12.33%for NK cell percentage.After using the optimal cutoff value to convert continuous variables into binary variables,Logistic regression analysis showed that a CD3^(+)CD8^(+)cell count<702.82 cells/μl and an NK cell percentage>12.33%were independent risk factors for URSA(OR>1,P<0.05).Conclusions:The decrease of CD3^(+)CD8^(+)cells in peripheral blood during midluteal phase is closely related to the occurrence of URSA.The number of CD3^(+)CD8^(+)cells(702.82 cells/l)and the percentage of NK cells(12.33%)can be used as reference values for the diagnosis and treatment of URSA.