原因不明性复发性流产淋巴细胞免疫治疗的剂量及疗效研究

目的：探讨原因不明性复发性流产（unexplained recurrent spontaneous abortion，URSA）患者再次妊娠结局及治疗前后患者外周血调节性T细胞水平的变化。方法对165例URSA患者进行主动免疫治疗，观察患者治疗后再次妊娠结局。同时检测和分析治疗前后患者外周血的CD4＋CD25＋Tr水平。将试验过程中供体血浆析出较少致使分离得到的淋巴细胞较少的患者37例作为低剂量组，较多者84例作为高剂量组。结果165例患者中，再次妊娠121例，仍在治疗中44例。再次妊娠的患者中成功分娩87例，再次发生早期流产14例，继续妊娠20例，主动免疫治疗成功率88.5%。其中低剂量组成功分娩29例，再次早期流产8例，主动免疫治疗成功率（72.4%）显著低于高剂量组（92.3%），差异有统计学意义（P＜0.05）。所有患者治疗后CD4＋CD25brightT表达水平均显著高于治疗前（P＜0.05）；妊娠成功患者外周血CD4＋CD25＋Tr及CD4＋CD25brightT均较妊娠失败者显著升高（P＜0.05）。结论主动免疫治疗对 URSA 患者有效，治疗时应注射高剂量淋巴细胞，主动免疫治疗可显著提高患者 CD4＋CD25brightT 的表达水平， CD4＋CD25brightT可能是调控母胎界面局部免疫耐受形成的一个重要因素。

Efficacy of immunotherapy with different doses for unexplained recurrent spontaneous abortion

Objective To assess the efficacy of lymphocyte therapy with different doses for unexplained recurrent spon-taneous abortion （URSA）. Methods One hundred and sixty five women with URSA received lymphocyte therapy with different doses. The outcomes of pregnancy were documented and the percentage of CD4＋CD25＋Tr in peripheral blood was measured by flow cytometry before and after lymphocyte therapy. Results Among 165 patients re- pregnancy was obtained in 121 cases, in whom 87 cases were successful y delivered, 14 cases had early abortion and 20 cases were stil under pregnancy with a success rate of 88.5%. Thirty seven cases with low dose treatment all obtained re- pregnancy, including 29 cases of successful delivery and 8 cases of early abortion with a success rate of 72.4%, which was significantly lower than that of high dose group （92.3%, P〈0.05）. After treatment the level of CD4 ＋CD25bright T was significantly （P〈0.05） higher than before treatment. The CD4 ＋CD25 ＋Tr and CD4 ＋CD25bright T levels in patients with successful pregnancy were significantly higher than those with failed pregnancy （P〈0.05）. Conclusion Lymphocyte therapy is effective for URSA women, particularly with high dose lymphocytes, which is associ-ated with increased CD4 ＋CD25bright T and CD4 ＋CD25bright Tr levels in peripheral blood.