胎膜早破外周血单个核细胞Th1/Th2免疫偏移的临床研究

目的 检测胎膜早破(PROM)外周血单个核细胞(PBMC)产生Th1/Th2细胞因子水平差异,探讨PROM 的Th1/Th2免疫偏移.方法 对足月胎膜早破(PROM)组39例、未足月胎膜早破(PPROM)组34例和正常足月妊娠组(对照组)38例3组的PBMC经植物血凝素(PHA)诱导后,用ELISA法测定上清液中的γ-干扰素(IFN-γ)和白细胞介素-4(IL-4)水平,同步检查绒毛羊膜炎病理改变,用PV-9000免疫组化两步法检测IFN-γ和IL-4在胎盘局部的表达.结果 3组PBMC分泌IFN-γ水平总体差异有统计学意义(F=36.313,P＜0.01)；其中PROM组IFN-γ为(158.6±38.9)ng/L,对照组为(105.3±33.6)ng/L,PPROM组为(201.4±29.2)ng/L,PROM组较对照组升高(q=6.438,P＜0.05),但低于PPROM组(q=4.033,P＜0.05)；3组PBMC分泌IL-4水平总体差异有统计学意义(F=23.291,P＜0.05)；其中PROM组IL-4水平较对照组降低(q=2.051,P＜0.05),但高于PPROM组(q=2.842,P＜0.05)；3组IFN-γ/IL-4比值总体差异有统计学意义(F=15.262,P＜0.05)；PPROM组绒毛羊膜炎病理改变明显,PROM组绒毛羊膜炎改变较轻；3组间IFN-γ在胎盘局部表达的总体差异有统计学意义(F=7.382,P＜0.05),PPROM组最高；3组间IL-4表达的总体差异有统计学意义(F=5.878,P＜0.05),PPROM组最低.结论 胎膜早破的免疫偏移状态表现为Th1型增强和Th2型减弱,Th1/Th2型免疫平衡指数IFN-γ/IL-4比值明显增高.

Clinical study on Th1/Th2 immunodeviation of peripheral blood mononuclear cells in premature rupture of membranes

OBJECTIVE To estimate the differences of Th1/Th2 cytokines produced by peripheral blood mononuclear cells(PBMC) in patients with premature rupture of membranes(PROM),moreover,to investigate the condition of Th1/Th2 immunodeviation.METHODS The PBMCs were isolated from 39 patients with PROM(PROM group),34 cases with preterm premature rupture of the membrane(PPROM group) and 38 subjects with normal pregnancy(Control group),followed by stimulating with phytohemagglutinin(PHA),the concentrations of IFN-γand IL-4 in the supernatant were determined by ELISA.The chorioamnionitis was determined by placental pathological examination,and the expressions of INF-γand interleukin 4 in the placenta were determined by PV-9000 immunohistochemical method.RESULTS There was statistical significance of overall differences in IFN-γ level among the three groups(F=36.313,P<0.01).The IFN-γ level in PROM group(158.6±38.9)ng/L was higher than that in control group(105.3±33.6)ng/L,PPROM group(201.4±29.2)ng/L(q= 6.438,P<0.05),but lower than that in PPROM group(q=4.033,P=0.041).There was statistical significance of overall differences of IL-4 level among the three groups(F=23.291,P<0.05);the IL-4 level in PROM group was lower than that in control group(q=2.051,P=0.046),but higher than that in PPROM group(q=2.842,P<0.05);there was statistical significance of overall differences in the ratio of IFN-γ/IL-4,among the three groups(F=15.262,P<0.05);the pathological change of chorioamnionitis was severe in the PPROM group and mild in the PROM group;there was statistical significance of overall differences in IFN-γ expression in the placenta among the three group.(F=7.382,P<0.05);and the PPROM was at the highest-level;similarly there was statistical significance of overall differences in IL-4 expression(F=5.878,P<0.05);the PPROM was at the lowest-level.CONCLUSION The condition of Th1/Th2 immunodeviation in PROM presents as high-level of Th1 type cytokines and low-level of Th2,and the Th1/Th2 imunodeviation index of IFN-γ/IL-4 apperantly increased.