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【目的】探讨不明原因复发性流产(URSA)患者处于难免流产和流产后非孕状态等不同临床情况时外周血免疫细胞特征及其临床意义。【方法】回顾性分析2008-2010年于我院诊疗的自然流产患者184例,就诊时为早期妊娠难免流产的URSA患者55例(URSA难免流产组),同期早期妊娠难免流产的偶发流产患者(sporadic abortion,SA)23例,作为对照(SA难免流产组)。此外,就诊时为未孕状态,距最后一次流产3个月以上URSA患者62例(URSA非孕组),同期未孕状态,距流产3个月以上SA患者44例作为对照(SA非孕组)。记录患者一般情况,包括年龄、月经周期。使用流式细胞术检测外周血免疫细胞,包括T淋巴细胞亚群:T细胞比例、Th细胞比例、Ts细胞比例、Th/Ts;其他免疫细胞:白细胞数量、淋巴细胞总数量(LYM细胞)、B细胞比例、自然杀伤细胞(NK细胞)比例。【结果】难免流产状态:URSA患者与SA患者Th/Ts均异常升高,前者为2.77±5.16,后者为3.67±6.12,URSA患者与SA患者比较,前者NK细胞比例明显升高,为(15.57±6.45)%,后者仅为(11.38±3.66)%,差异有统计学意义(P<0.05)。非孕状态:URSA患者与SA患者比较,URSA患者WBC数量及NK细胞比例高于SA组,前者为(6.27±1.09)×109、(18.26±7.88)%,后者为(5.59±1.16)×109、(11.0±6.8)%,差异有统计学意义(P<0.05)。【结论】在发生早期妊娠难免流产时,URSA患者与SA患者均存在一定的免疫紊乱,共同的表现是特异性免疫方面均有Th/Ts异常升高,不同的表现是,URSA患者在非特异性免疫方面存在NK细胞比例增高。在非孕状态,SA患者免疫紊乱得到调整回复正常,URSA患者仍然存在一定的免疫紊乱,主要表现在非特异性免疫方面,以WBC数量和NK细胞比例增高为主。临床工作中应注意监测URSA患者的免疫状态。
【Objective】 To investigate the characteristics and clinical significance of peripheral blood immune cells in patients with unexplained recurrent spontaneous abortion (URSA) in different clinical situations, such as unavoidable abortion and abortion. 【Methods】 A total of 184 patients with spontaneous abortion diagnosed and treated in our hospital from 2008 to 2010 were retrospectively analyzed. Fifty-five URSA patients (URSA unavoidable abortion group) with unavoidable miscarriage during the first trimester were diagnosed in the first trimester of pregnancy. In the same period, Sporadic abortion, SA) 23 cases, as a control (SA inevitable abortion group). In addition, the non-pregnant status at the time of treatment, from the last miscarriage more than 3 months in 62 patients with URSA (URSA non-pregnant group), the same period of non-pregnancy, 44 cases of abortion more than 3 months SA patients as control (SA non-pregnant group ). Record the general situation of patients, including age, menstrual cycle. Flow cytometry was used to detect peripheral blood immune cells including T lymphocyte subsets: T cell ratio, Th cell ratio, Ts cell ratio, Th / Ts; other immune cells: white blood cell count, total lymphocyte count B cell ratio, natural killer cell (NK cell) ratio. 【Results】 The status of unavoidable abortion: The Th / Ts of URSA patients and SA patients were abnormally elevated, the former was 2.77 ± 5.16 and the latter was 3.67 ± 6.12. The proportion of NK cells in URSA patients and SA patients was significantly higher than that of SA patients ( 15.57 ± 6.45)%, while the latter only (11.38 ± 3.66)%, the difference was statistically significant (P <0.05). Non-pregnant status: Compared with SA patients, the number of WBC and the proportion of NK cells in URSA patients were significantly higher than those in SA patients (6.27 ± 1.09) × 109, (18.26 ± 7.88)% and (5.59 ± 1.16) × 109, (11.0 ± 6.8)%, the difference was statistically significant (P <0.05). 【Conclusion】 URSA patients and SA patients have some immune disorders in the early pregnancy with unavoidable abortion. The common manifestations are all the abnormal Th / Ts abnormalities in the specific immunity. The different manifestations are the nonspecific There is an increase in the proportion of immune NK cells. In non-pregnant state, SA patients with immune disorders were adjusted back to normal, URSA patients still exist some immune disorders, mainly in the non-specific immunization, the number of WBC and the proportion of NK cells mainly. In clinical practice, care should be taken to monitor the immune status of URSA patients.