复发性自然流产患者主动免疫治疗前后外周血淋巴细胞Fas/FasL表达水平的研究

目的研究复发性自然流产(RSA)患者外周血淋巴细胞Fas/FasL表达水平,探讨Fas/FasL系统与RSA的发病关系以及主动免疫治疗对RSA患者外周血淋巴细胞Fas/FasL表达水平的影响。方法收集2009年6月至2010年4月在汕头大学医学院附属粤北人民医院妇产科门诊就诊的早孕期RSA患者12例,未孕期RSA患者15例作为研究组,采用荧光标记流式细胞分析技术分别检测主动免疫治疗前后外周血淋巴细胞Fas、FasL表达水平,选择同期正常早孕妇女15例,正常未孕妇女15例作为对照组,比较各组Fas、FasL表达水平的差异。结果 (1)未孕组中,RSA患者外周血NK细胞和CD8+T细胞Fas的表达水平均比正常妇女高,NK细胞FasL表达水平比正常妇女低(P<0.05),CD8+T细胞FasL、CD4+T细胞Fas、FasL的表达水平两组相比无明显差异(P>0.05);(2)早孕组中,RSA患者外周血NK细胞Fas、FasL的表达水平均比正常妇女低,CD8+T细胞Fas表达水平比正常妇女高(P<0.05),CD8+T细胞FasL、CD4+T细胞Fas、FasL的表达水平两组相比则无明显差异(P>0.05);(3)主动免疫治疗后RSA患者(早孕组和未孕组)外周血NK细胞和CD8+T细胞的Fas表达水平均较治疗前下降,FasL表达水平均较治疗前上升,差异有统计学意义(P<0.05),CD4+T细胞Fas、FasL的表达水平与治疗前相比无明显差异(P>0.05)。结论 (1)外周血NK细胞和CD8+T细胞Fas表达升高,FasL表达不足是导致RSA发生的重要免疫学因素之一。(2)主动免疫治疗可能通过改变RSA患者外周血NK细胞和CD8+T细胞的Fas/FasL表达水平,改善细胞凋亡状态而取得疗效。

Study on expressions of the Fas/Fas Ligand of the lymphocytes in peripheral blood in women with recurrent spontaneous abortion before and after active immunotherapy.

Objective：Through investigating the expression of the Fas/Fas Ligand（FasL） of lymphocytes in peripheral blood of women with recurrent spontaneous abortion,to explore the role of Fas/FasL in the morbidity of RSA and alterations of the expression of Fas/FasL after active immunotherapy.Methods：The objects of observation were outpatients between June 2009 to April 2010 in Shantou University medical college affiliated Yuebei People′s hospital.Setting 12 early pregnant RSA patients,15 nonpregnant RSA patients as experimental groups,and 15 normal early pregnancy,15 normal nonpregnancy as control groups.Flow cytometry was applied to detect the expressions of the Fas/FasL on the lymphocytes in peripheral blood.Results：（1） The expressions of Fas in NK cells and CD8＋T cells in nonpregnant RSA patients were significantly higher than that of normal nonpregnancy,while the expressions of FasL in NK cells were significantly lower（P0.05）,the expressions of FasL in CD8＋T cells and Fas,FasL in CD4＋T cells did not differ between two groups（P0.05）;（2） The expressions of Fas,FasL in NK cells in early pregnant RSA patients were significantly lower than that of normal early pregnancy,and the expressions of Fas in CD8＋T cells were higher（P0.05）,the expressions of FasL in CD8＋T cells and Fas,FasL in CD4＋T cells did not differ between two groups（P0.05）;（3） The expressions of Fas in NK cells and CD8＋T cells in RSA patients decreased,and the expressions of FasL in which increased after active immunotherapy（P0.05）,the expressions of Fas,FasL in CD4＋T cells did not change after active immunotherapy（P0.05）.Conclusions：（1） The hyperexpressions of Fas and the hypoexpressions of FasL in NK cells and CD8＋T cells in peripheral blood is one of the important immunological factors which inducing the occurrence of RSA.（2） Active immunotherapy can regulate the expressions of Fas/FasL in NK cells and CD8＋T cells in RSA patients,which contributes to reduce apoptotic cell death,and leads to a successful outcome finally.