反复自然流产患者主动免疫治疗后封闭抗体和调节性T细胞水平变化

目的 探讨主动免疫治疗反复自然流产(RSA)的妊娠结局及治疗前后外周血封闭抗体(BA)、CD₄⁺CD₂₅⁺T细胞和CD₄⁺CD₂₅^highTreg细胞水平的变化。方法 运用微量淋巴细胞毒试验(MLCT)检测BA,随机选取300例阴性患者行淋巴细胞主动免疫治疗,并随访妊娠结局;随机选取100例患者流式细胞术检测外周血封闭效率、CD₄⁺CD₂₅⁺T细胞和CD₄⁺CD₂₅^highTreg水平。结果 接受主动免疫治疗的300例患者中,265例妊娠,35例仍在治疗中。再次妊娠的患者中10例发生早期流产,165例已成功分娩,90例仍在继续妊娠中,治疗的成功率达96.2%。100例患者BA水平主动免疫治疗后(37.73±2.42%)较治疗前(7.25±0.39%)明显升高,CD₃、CD₄、CD₂₅封闭抗体效率均较治疗前升高,其中CD₃和CD₂₅抗体升高非常显著(P＜0.01);CD₄⁺CD₂₅⁺T细胞和CD₄⁺CD₂₅^highTreg细胞的比率均明显高于主动免疫治疗前,差异有统计学意义(P＜0.01,P＜0.05)。结论 RSA的发生可能与患者外周血中封闭抗体、CD₄⁺CD₂₅⁺T细胞、CD₄⁺CD₂₅⁺ Treg减少有关。淋巴细胞主动免疫治疗能够显著提高患者外周血封闭抗体水平、CD₄⁺CD₂₅⁺ T细胞和CD₄⁺CD₂₅^highTreg的比率,是治疗RSA的一种安全有效的方法。

Changes in the levels of blocking antibody and regulatory T cells after active immunotherapy in patients with recurrent spontaneous abortion

Objective To investigate the pregnancy outcome by active immunotherapy for recurrent spontaneous abortions(RSA) and the changes of blocking antibody (BA) and the levels of CD₄⁺CD₂₅⁺T cells and CD₄⁺CD₂₅^highTreg cells in peripheral blood after immunotherapy.Methods Detection of BA by micro lymphocytic toxicity test (MLCT),300 negative patients randomly selected were treated by active immunotherapy of lymphocytes, and the pregnancy outcomes were followed. Blocking efficiency and the levels of CD₄⁺CD₂₅⁺T cells and CD₄⁺CD₂₅^highTreg cells in peripheral blood were detected by flow cytometry in 100 cases randomly selected.Results Of the 300 patients receiving active immunotherapy,265 were pregnant,and 35 were still in the immunotherapy.In the patients with pregnancy,10 cases had an early abortion,165 had successful delivery and 90 were still pregnant, and the success rate of the active immunotherapy was 96.2%. The level of BA was significantly higher after active immunotherapy (37.73±2.42%) than that before immunotherapy (7.25±0.39%) in 100 patients.The blocking efficiencies of CD₃,CD₄ and CD₂₅ were higher than that before immunotherapy,and CD₃ and CD₂₅ increased very significantly (P＜0.01).The ratios of CD₄⁺CD₂₅⁺T cells and CD₄+CD₂₅^highTreg cells were significantly higher than that before active immunotherapy,and the difference was statistically significant(P＜0.01,P＜0.05).Conclusion The occurrence of RSA may be related to the decreases of blocking antibody,CD₄⁺CD₂₅⁺T cells and CD₄⁺CD₂₅^highTreg cells in the peripheral blood of the patients.Lymphocyte active immunotherapy can significantly improve the levels of blocking antibody and the ratios of CD₄⁺CD₂₅⁺T cells and CD₄⁺CD₂₅^highTreg cells in peripheral blood. It is a safe and effective way to treat RSA.