不明原因习惯性流产患者主动免疫治疗前后Th1/Th2型细胞因子水平的变化

Changes in the Levels of Th1 and Th2 type Cytokines after Immunotherapy in Women with Unexplained Habitual Abortions

为探讨主动免疫治疗对不明原因习惯性流产 (UHA )患者Th1/Th2型细胞因子水平的影响。采用酶联免疫吸附法检测15例正常非妊娠妇女、 35例UHA患者淋巴细胞主动免疫治疗前后经滋养细胞抗原刺激的外周血单个核细胞 (PBMC )培养上清液中IL 2、IFN γ、IL 4、IL 10的水平。结果发现 :(1)在最佳诱导时间下 ,UHA组治疗前PBMC产生IL 2、IFN γ的水平明显高于正常对照组 (P <0 0 5 ) ,IL 4、IL 10水平明显低于正常对照组 (P <0 0 5 )。UHA组治疗后PBMC产生IL 2、IFN γ的水平较治疗前明显降低 (P <0 0 5 ) ,IL 4、IL 10水平较治疗前明显升高 (P <0 0 5 )。UHA组治疗后PBMC产生各细胞因子的水平与正常对照组比较 ,差异均无显著性 (P >0 0 5 ) ;(2 )UHA组 35例患者主动免疫治疗后半年内 2 8例妊娠 ,其中 9例又出现自然流产。 9例自然流产者治疗后IL 2、IFN γ水平未明显下降 ,IL 10水平未明显上升。 19例妊娠成功者治疗后IL 2、IFN γ水平较治疗前明显下降 (P <0 0 5 ) ,IL 4、IL 10水平明显上升 (P <0 0 5 )。以上结果表明UHA患者对滋养细胞抗原产生以Th1型反应为主的免疫应答 ,产生大量Th1型细胞因子 ,主动免疫治疗有助于上调Th2型细胞因子及下调Th1型细胞因子 ,利于UHA患者妊娠成功。

To investigate the influence of active immunotherapy on the levels of Th1 and Th2 type cytokines in women with unexplained habitual abortions,the concentrations of IFN-γ,IL-2,IL-4 and IL-10 in the supernatants of cell cultures of trophoblast-activated peripheral blood mononuclear cells (PBMC) from 35 cases before and after active immunotherapy were determined by means of ELISA. 15 cases of non-pregnant women were chosen as controls. The results showed that the levels of IL-2 and IFN-γ were significantly higher than those of the controls before active immunotherapy,but the levels of IL-4 and IL-10 were lower than those of the controls. After active immunotherapy,the levels of IL-2 and IFN-γ were dropped,whereas those of IL-4 and IL-10 were elevated in women with unexplained habitual abortions. Of these 35 cases of women after active immunotherapy,28 cases experienced pregnancies,and 9 cases developed natural abortions whose IL-2,IFN-γ levels were not decreased and IL-10 not increased significantly. But other 19 cases with normal pregnancy showed a decreased levels of IL-2 and IFN-γ and an increased levels of IL-4 and IL-10.These results indicate that the cases with unexplained abortions showed a Th1 type cytokine responses to trophoblasts which probably mediate pregnancy loss. Active immunotherapy could induce a shift from Th1 to Th2 response,thus favoring maintenance of normal pregnancy.