尹建蓝　陈慧

[摘要] 目的 从原因不明复发性流产患者的外周血T淋巴细胞表型分析其可能发病机制。方法 方便选择2014年1月—2016年12月就诊的因不明原因导致复发性流产的患者共40例，随机收集同期自愿要求终止妊娠的健康早孕妇女70名，检测两组外周血清淋巴免疫表型分布差异。结果 ①URSA组CD4+ CD8+比例（1.59±0.61）%、CD4+CD8-/CD3+T细胞比率（52.3±6.4）%明显高于正常组（1.31±0.52）%、（49.1±5.4）%（t1=2.55，P1=0.012； t2=2.79，P2=0.001）。②与正常早孕组相比，URSA组CD4+HLA-DR+/CD4+比率差异无统计学意义（t=0.60，P=0.552）；而CD3+HLA-DR+/CD3+[（24.8±6.2）% vs （20.4±5.7）%]、CD8+HLA-DR+/CD8+ [（35.6±10.1）% vs （24.9±9.1）%]比率明显增加，差异有统计学意义（t1=3.77，P1=0.000；t2=5.70，P2=0.000）。结论 CD4+ CD8+细胞比例增加、外周血T淋巴细胞的活化可能是导致URSA发病的免疫基础，活化T细胞表型可考虑作为URSA检测得辅助诊断指标。

[关键词] 复发性流产；淋巴细胞；诊断

[中图分类号] R4 [文献标识码] A [文章编号] 1674-0742（2018）04（c）-0042-03

Analysis of Peripheral Blood T Lymphocyte Phenotype of Patients with Unexplained Recurrent Abortion

YIN Jian-lan1， CHEN Hui2

1.Department of Obstetrics， Dongguan Maternal and Infant Healthcare Hospital， Dongguan， Guangdong Province， 523112 China；2.Department of Obstetrics， Second Affiliated Hospital of Zhongshan University， Guangzhou，Guangdong Province， 510120 China

[Abstract] Objective To analyze the possible onset mechanism of peripheral blood T lymphocyte phenotype of patients with unexplained recurrent abortion. Methods 40 cases of patients with unexplained recurrent abortion diagnosed in our hospital from January 2014 to December 2016 were selected， 70 cases of healthy women with early pregnancy who volunteered to terminate the pregnancy at the same period were collected， and the difference in the distribution of peripheral blood T lymphocyte phenotype was tested. Results The CD4+ CD8+ ratio and CD4+CD8-/CD3+T cell ratio in the URSA group were obviously higher than those in the normal group[（1.59±0.61）%， （52.3±6.4）% vs （1.31±0.52）%， （49.1±5.4）%] （t1=2.55，P1=0.012；t2=2.79，P2=0.001）， and the difference in the CD4+HLA-DR+/CD4+ ratio between the two groups was not obvious（t=0.60， P=0.552）， and the CD3+HLA-DR+/CD3+ ratio and CD8+HLA-DR+/CD8+ ratio obviously increased，[（24.8±6.2）% vs（20.4±5.7）%]， [（35.6±10.1）% vs （24.9±9.1）%]， and the differences were statistically significant （t1=3.77，P1=0.000；t2=5.70，P2=0.000）. Conclusion The increase of CD4+ CD8+ cell and activation of peripheral blood T lymphocyte phenotype may the immune basis of the URSA onset， and the activation of T cell phenotype can be considered as the adjunctive diagnosis index of URSA test.

[Key words] Recurrent abortion； Lymphocyte； Diagnosis

復发性流产（RecurrentspontaneousAbortion，RSA）发病率在育龄妇女中约2%～3%，多指相同的性伴侣发生2次或2次以上的自然流产现象[1]。RSA的病因复杂，近半数RSA患者无法通过现有的临床诊断方法进行识别且治疗效果并不理想，又称不明原因反复自然流产（URSA）[2]。URSA易复发，严重影响妇女身体健康。寻找原因不明复发性流产发病机制，对于该病诊治及后续疾病进展有重要意义，早期研究显示[3]，T淋巴细胞亚群紊乱可能与本病相关，该文由此提出对2014年1月—2016年12月间该该院接收治疗的40例URSA患者外周血T淋巴细胞表型进行分析，以找寻其可能发病机制，现报道如下。

1 资料与方法

1.1 一般资料

方便选取40例于该院接受治疗的URSA患者作为研究对象，入选标准：经超声检查后初步判断孕卵枯萎或者胚胎停止发育，胎儿心脏无跳动或者未发现原始胚胎；……