淋巴细胞免疫治疗对不明原因复发性流产患者外周血T细胞的影响

目的探讨淋巴细胞免疫治疗(LIT)对不明原因复发性流产(uRM)患者外周血T淋巴细胞比例和功能的影响。方法对94例uRM患者进行3次LIT治疗,治疗前后均在其黄体中期采集外周血,并采用流式细胞术检测其外周血T淋巴细胞亚群比例和Th1/Th2型细胞因子。结果 94例患者中26例失访,7例生化妊娠,2例异位妊娠,48例成功分娩,11例再次自然流产。所有患者3次LIT治疗后与治疗前比较,外周血CD3+T淋巴细胞占淋巴细胞的比例、CD3+CD4+CD8-T细胞和CD3+CD4-CD8+T细胞分别占CD3+T细胞的比例,以及产生γ干扰素(IFN-γ)的Th1细胞占Th细胞比例均无显著性差异(P0.05);而产生肿瘤坏死因子α(TNF-α)的Th1细胞占Th细胞的比例、IFN-γ/白细胞介素-10(IL-10)比值和TNF-α/IL-10比值在治疗后均显著性降低(P0.05)。进一步研究显示,LIT治疗前后成功妊娠患者和再次流产患者的T细胞亚群均无显著性变化(P0.05);Th1/Th2比值在成功妊娠患者中显著下降(P0.001),而再次流产患者中并无显著性变化(P0.05)。结论 LIT改变uRM患者外周血T细胞的功能,降低Th1/Th2比值,使患者趋于以Th2为主的免疫状态而有利于成功妊娠。

Impact of lymphocyte immunotherapy on peripheral blood T lymphocytes in patients with unexplained recurrent miscarriage

Objective：To investigate the impact of lymphocyte immunotherapy（LIT）on the percentage and function of peripheral blood T lymphocytes in patients with unexplained recurrent miscarriage（uRM）.Methods：A total of 94 patients with a history of uRM received the LIT.The peripheral blood was collected during the mid-luteal phase before and after LIT.Then the percentage of T lymphocytes and Th1/Th2 cytokine-producing cells were assessed by flow cytometric analysis.Results：Among the 94 patients with uRM,7patients were biochemical pregnancy,2patients ectopic pregnancy,48 patients successful delivery,11 patients miscarriage,and 26 patients were lost to follow up.There were no significant differences in the percentages of CD^3＋T cells in peripheral blood lymphocytes,the percentages of CD^3＋CD4＋CD8-T cells and CD^3＋CD^4-CD^8＋T cells in CD^3＋T cells,as well as the percentages of Th1 cells producing IFN-γin Th cells before and after three times LIT in all patients（all P〉0.05）.The percentage of Th1 cells producing TNF-αin Th cells,and the ratios of IFN-γ/IL-10 or TNF-α/IL-10 were significantly decreased after LIT in all patients（all P〈 0.05）.In addition,the percentages of T subpopulations were no significantly different before and after LIT in successful pregnant patients and miscarriage patients.The ratio of Th1/Th2 cells was significantly decreased after LIT in successful pregnant patients（P〈0.001）,while no significant difference was found after LIT in miscarriage patients（P〉0.05）.Conclusions：LIT decreases the ratio of Th1/Th2 cells,so then induces a dominant state of Th2 cells in the patients with uRM.It may benefit for pregnancy maintenance.