卵巢早衰60例临床特征及自身免疫变化分析

目的了解卵巢早衰（Premature ovarian failure POF）患者的临床特征及自身免疫状况。探讨自身免疫异常在POF发生发展中的作用,为早期预测及临床治疗POF提供新途径。方法分析60例POF患者的临床特征。对POF患者（POF组）与70例健康育龄妇女（对照组）的临床数据进行比较。用酶联吸附实验测定两组性激素促卵泡生成素（FSH）,雌激素（E2）及血清中InIrA,InIrB水平。用流式细胞仪检测两组外周血CD4＋、CD8＋及CD4＋/CD8＋变化。结果POF组BIM大于对照组（P〈0.05）,POF组子宫及卵巢体积明显减小（P〈0.01）,POF组初潮年龄与对照组差别无统计学意义（P〉0.05）。POF组CD4＋低于对照组（P〈0.05）,CD8＋明显高于对照组（P〈0.01）,CD4＋/CD8＋明显降低（P〈0.01）,POF组血清抑制素A、BCInhA、B下降（P〈0.05）。通过线性相关性分析显示：CD4＋、CD4＋/CD8＋分别与E2呈正相关,CD8＋与E2呈负相关。结论遗传因素和自身免疫因素与POF的发病有关系,E2有免疫抑制作用,可抑制T细胞免疫应答,血清Ihn水平下降和外周血T淋巴细胞亚群的变化可做为早期预测POF的参考指标。

Analysis of clinical feature and autoimmune status of 60 cases with premature ovarian failure

Objective To investigate clinical feature and autoimmune status of patients with premature ovarian failure（POF）,and discuss the effect of autoimmune abnormality on development of POF for early diagnosis and therapy of the disease.Methods Sixty cases with POF were collected from Oct.2005 to Oct.2007 and their clinical features were compared with 70 healthy women of child-bearing age（control group）.The serum levels of follicle-stimulating hormone（FSH）,estrogen（E2）,InIrA and InIrB in both groups were detected by ELISA,and the change of levels of peripheral CD4＋,CD8＋ and CD4＋/CD8＋ were determined by FASC.The relationship between levels of hormone and that of CD4＋,CD8＋ or CD4＋/CD8＋ was analyzed by linear correlation analysis.Results BIM in POF group was more than that of control group（P〈0.05）,but the volume of uterus and ovaries was smaller（P〈0.01）.The age of menarche in POF group was no statistically difference with control group（P〉0.05）.The number of CD4＋ in POF group was lower than that of control group（P〈0.05）;the number of CD8＋ was obviously higher（P〈0.01）,and the ratio of CD4＋/CD8＋ decreased（P〈0.01）.The serum level of InIrA or InIrB in POF group was lower than that of control group（P〈0.05）.There were positive correlation between CD4＋,CD4＋/CD8＋ and E2,and negative correlation between CD8＋ and E2.Conclusion The factors of heredity and autoimmune status affect the episode of POF.The E2 has immunosuppressive effects on T cell-mediated immunity.The decrease of serum Ihn level and the change of peripheral T lymphocyte subpopulation can be used as reference index for early prediction of POF.