马超++冯文华

[摘要]目的 探讨原因不明反复流产（URSA）患者外周血中T淋巴细胞亚群和NK细胞的变化。方法 选取2014年3月～2016年3月辽宁省计划生育科研院附属医院门诊确诊为不明原因流产患者50例作为观察组，并选取同期就诊的30例健康早孕妇女作为对照组。采用流式细胞仪检测两组妇女的外周血T淋巴细胞亚群和NK细胞水平。结果 观察组外周血中CD4+和CD4+/CD8+比率明显高于对照组，差异有统计学意义（P<0.05），而两组CD3+和CD8+比率比较，差异无统计学意义（P>0.05）。观察组外周血中NK细胞比率也明显高于对照组，差异有统计学意义（P<0.05）。结论 URSA患者外周血中CD4+、CD4+/CD8+和NK细胞比率的升高，打破了正常的妊娠免疫微环境而引发流产。

[关键词]原因不明反复流产；T淋巴细胞亚群；自然杀伤细胞；流式细胞术

[中图分类号] R714.21 [文献标识码] A [文章编号] 1674-4721（2017）04（a）-0087-03

Molecular Genetics Laboratory，Liaoning Province Research Institute of Family Planning，Shenyang 110031，China

[Abstract]Objective To explore the changes of T lymphocytes sub-types and NK cells in patients with unexplained recurrent abortion.Methods The patients were collected in the Liaoning Province Research Institute of Family Planning from March 2014 to March 2016. The 50 patients with URSA were selected as the observation group and 30 patients with voluntary abortion were selected as the control group.Flow cytometry was used to measure the number of T lymphocytes sub-types and NK cells in the two groups.Results The percentages of CD4+ and ratio of CD4+/CD8+ was significantly increased in peripheral blood of unexplained recurrent abortion patients （P<0.05），while there was no significantly differences in CD3+ and CD8+ （P>0.05）.The level of NK cell was also significantly increased in peripheral blood of unexplained recurrent patients（P<0.05）.Conclusion The increasing level of CD4+，CD4+/CD8+ and NK cells in peripheral blood of recurrent abortion patients is harmful to maintain pregnancy even induced abortion.

[Key words]Unexplained recurrent abortion；T lymphocytes sub-types；NK cells；Flow cytometry

反复自然流产（recurrent spontaneous abortion，RSA）是指连续发生了2次或2次以上的自然流产，是一种常见的妊娠并发症[1]。其主要原因有染色体异常、感染、内分泌失调和凝血异常，而排除这些因素后，其中有40%～80%的患者原因不明，称为不明原因反复自然流产（unexplained recurrent spontaneous abortion，URSA）[2]。正常妊娠需要母体建立起一个对胎儿局部免疫耐受的环境，如果免疫微环境失调则会导致流产的发生[3]。URSA是育龄妇女常见的妊娠并发症，已经成为困扰育龄妇女和临床工作者的一大难题，其发病机制目前尚不清楚。免疫因素在维持正常妊娠起着关键作用，T淋巴细胞亚群及自然杀伤细胞（natural killer，NK）在妊娠免疫中越来越受到重视，本研究通过比较URSA患者与健康早孕妇女外周血中T淋巴細胞亚群和NK细胞比率，探讨URSA患者外周血中免疫细胞的变化，同时为URSA患者治疗提供理论依据，避免流产的发生。……