不明原因复发性流产患者胸腺和胸腺外来源的调节性T细胞表达及检测意义

Expression and significance of regulatory T cells in thymus and extra-thymus in patients with unknown recurrent abortion

目的探讨不明原因复发性流产(URSA)患者胸腺和胸腺外来源(外周)的调节性T细胞表达及检测意义。方法采用前瞻性研究,选取2021年4月至2023年4月深圳市人民医院收治的63例URSA患者,纳入观察组,63例行乳腺部分切除手术后正常妊娠者纳入对照组。观察组年龄(28.10±2.94)岁,体重指数(27.56±2.81)kg/m^(2)。对照组年龄(28.31±2.97)岁;体重指数(27.29±2.75)kg/m^(2)。检测并比较两组研究对象胸腺和外周的CD4^(+)CD25^(+)Tr细胞表达水平。组间比较采用独立样本t检验、χ^(2)检验,绘制受试者操作特征曲线(ROC),明确两项指标单独检测与联合检测的最佳截断值、曲线下面积(AUC),分析两项指标单独与联合检测对URSA发生风险的预测价值。结果观察组胸腺、外周CD4^(+)CD25^(+)Tr细胞表达水平分别为(7.92±0.86)%、(7.18±0.79)%,均低于对照组[(11.75±1.23)%、(11.03±1.07)%,差异均有统计学意义(均P<0.05)。胸腺、外周CD4^(+)CD25^(+)Tr细胞单独和联合预测URSA的AUC分别为0.779、0.760、0.875(P<0.05)。胸腺、外周CD4^(+)CD25^(+)Tr细胞联合预测URSA的灵敏度、特异度与准确率分别为95.24%(60/63)、96.83%(61/63)、96.03%(121/126),均高于胸腺、外周CD4^(+)CD25^(+)Tr细胞单独检测[76.19%(48/63)、79.37%(50/63)、77.78%(98/126)及73.02%(46/63)、74.60%(47/63)、73.81%(93/126)],差异均有统计学意义(均P<0.05)。结论URSA患者胸腺与外周CD4^(+)CD25^(+)Tr细胞表达水平下降,两项指标联合检测可在一定程度上预测孕妇的流产风险,为后续相关治疗干预提供数据参考。

Objective To investigate the expression and detection significance of regulatory T cells in the thymus and extra-thymus of patients with unknown recurrent abortion(URSA).Methods Sixty-three patients with URSA treated at Shenzhen People's Hospital from April 2021 to April 2023 were selected as an observation group,and 63 normal pregnant women after partial mastectomy a control group.The observation group were(28.10±2.94)years old;their body mass index was(27.56±2.81)kg/m^(2).The control group were(28.31±2.97)years old;their body mass index was(27.29±2.75)kg/m^(2).The expression levels of thymus and extra-thymus regulatory T cells in the two groups were detected.The expression levels of thymus and extra-thymus CD4^(+)CD25^(+)Tr cells were compared between the two groups.The data were compared between the two groups by the independent-sample t test andχ^(2)test.The receiver operating characteristic curve(ROC)was drawn based on the detection results.The best cutoff values and areas under the curves(AUC)of the two indicators were determined.The prediction values of the two indicators for the occurrence risk of URSA were analyzed.Results The expression levels of thymus and extra-thymus CD4^(+)CD25^(+)Tr cells in observation group were lower than those in the control group[(7.92±0.86)%vs.(11.75±1.23)%and(7.18±0.79)%vs.(11.03±1.07)%],with statistical differences(both P<0.05).The AUC's of thymus and extra-thymus CD4^(+)CD25^(+)Tr cells and their combination in the prediction of URSA were 0.779,0.760,and 0.875(P<0.05).The sensitivity,specificity,and accuracy of the combination in the prediction of URSA were 95.24%(60/63),96.83%(61/63),and 96.03%(121/126),respectively,which were higher than those of thymus CD4^(+)CD25^(+)Tr cells[76.19%(48/63),79.37%(50/63),and 77.78%(98/126)]and those of extra-thymus CD4^(+)CD25^(+)Tr cells[(73.02%(46/63),74.60%(47/63),and 73.81%(93/126)](all P<0.05).Conclusions The expression levels of thymus and extra-thymus CD4^(+)CD25^(+)Tr cells in patients with URSA decrease.Clinical combined detection of the above two indicators can predict the risk of abortion in pregnant women to a certain extent,and provide data references for subsequent relevant treatment and intervention.