早孕期蜕膜免疫细胞谱及其与妊娠结局的相关性

目的探讨早孕期蜕膜免疫细胞谱变化及稽留流产对妊娠免疫细胞谱的影响。方法选取2017年9月至2018年9月深圳中山泌尿外科医院收治的行人工流产的正常早孕患者(人工流产组,n=34),行清宫术的稽留流产患者(稽留流产组,n=17)及同期于本院IVF助孕成功的正常妇女(正常内膜组,n=27)作为研究对象。运用免疫组化及数字化分析系统定量检测正常妇女子宫内膜及流产组蜕膜组织中各免疫细胞的检测阳性率。结果早孕期妊娠前后的免疫细胞谱有如下改变:妊娠早期人工流产组蜕膜CD56⁺自然杀伤(NK)细胞、CD68⁺巨噬细胞、CD83⁺成熟树突状细胞数均显著高于正常内膜组(P<0.001),而CD8⁺T细胞、Foxp3⁺调节性T(Treg)细胞及CD1a⁺未成熟树突状细胞在两组之间则无显著差异(P>0.05)。在不良妊娠结局稽留流产组患者蜕膜组织中CD68⁺巨噬细胞、CD8⁺T细胞及Foxp3⁺调节性T(Treg)细胞数均显著高于人工流产组(P<0.05),而CD56⁺自然杀伤(NK)细胞、CD83⁺成熟树突状细胞及CD1a⁺未成熟树突状细胞与人工流产组相比无显著差异(P>0.05)。结论早孕期蜕膜中NK细胞、巨噬细胞及成熟树突状细胞的适度增加有利于母胎免疫耐受的形成,但异常高表达的蜕膜巨噬细胞、CD8⁺T细胞及Foxp3⁺Treg细胞可能与不良妊娠结局有关。

Decidual immune cells profile in early pregnancy and its association with pregnancy

Objective:To investigate the changes of decidual immune cell profile in early pregnancy and the effect of missed abortion on pregnancy immune cell profile.Methods:Thirty-four patients with normal early pregnancy for abortion(abortion group)and 17 missed abortion patients undergone curettage(missed abortion group)were selected in Shenzhen Zhoushan Urology Hospital from September 2017 to September 2018.Twenty-seven normal women with successful IVF in our hospital during the same period were selected as normal endometrium group.Immunohistochemistry and digital analysis system were used to quantitatively detect the positive rate of immunocytes in normal endometrium and decidua of abortion group.Results:The immune cells in early stage of pregnancy had following changes:the percentages of CD56+NK cells,CD68+macrophages and CD83+mature dendritic cells in decidua of women with normal pregnancy were significantly higher than those in normal endometrium group(P<0.001),while there were no significant differences in CD8+T cells,Foxp3+Treg cells and CD1a+immature dendritic cells between these groups(P>0.05).CD68+macrophages,CD8+T cells and Foxp3+Treg cells in the decidual tissues of the missed abortion group were significantly higher than the induced abortion group(P<0.05),while there were no significant differences in CD56+NK cells,CD83+mature dendritic cells and CD1a+immature dendritic cells between these groups(P>0.05).Conclusions:The moderate increase of NK cells,macrophages and mature dendritic cells in decidua of early pregnancy is conducive to the formation of maternal fetal immune tolerance,but the abnormal high expression of decidual macrophages,CD8+T cells and Foxp3+Treg cells may be associated with adverse pregnancy outcomes.