摘要
目的:研究外周血淋巴细胞注射主动免疫联合口服地屈孕酮治疗同种免疫型复发性流产的疗效。方法:将2015年1月至2016年12月在东莞市仁康医院接受淋巴细胞注射联合口服地屈孕酮治疗的200例同种免疫型复发性流产患者作为观察对象,按照对照、平行原则选取同期不愿接受淋巴细胞注射治疗的100例同种免疫型复发性流产患者作为对照组。对照组成功妊娠后给予淋巴细胞注射联合口服地屈孕酮,观察组则于孕前开始淋巴细胞注射治疗,成功妊娠后口服地屈孕酮。对比两组流产率、孕12周数、妊娠成功率、封闭抗体(BA)转阳率、BA阳性及阴性患者妊娠结局,并比较治疗前后CD3+、CD4+、CD8+、CD4+/CD8+T淋巴细胞水平。结果:治疗后,300例患者经超声均提示妊娠;观察组流产病例数显著低于对照组,孕12周及成功妊娠病例显著高于对照组(P<0.05);观察组BA转阳率显著高于对照组(P<0.01)。观察组BA(+)患者流产数低于对照组BA(+)患者,孕12周及成功妊娠病例高于对照组BA(+)患者(P<0.05);观察组CD3+T、CD8+T淋巴细胞上升,CD4+、CD4+/CD8+T淋巴细胞下降(P<0.05),除CD3+T淋巴细胞外,其他淋巴细胞水平变化幅度均大于对照组(P<0.05)。结论:孕前外周血淋巴细胞注射主动免疫联合口服地屈孕酮,对提升同种免疫型复发性流产患者妊娠成功率,降低流产率,改善母体免疫状态具重要价值。
Objective: To investigate the effect of active immunization with injection of peripheral blood lymphocytes and oral Dydrogestrone in the treatment of isoimmune spontaneous recurrent abortion. Methods: A total of 200 patients with isoimmune spontaneous recurrent abortion,treated with lymphocyte injection and oral Dydrogestrone in Dongguan Renkang Hospital between January 2015 and December 2016,were included as the subjects in the study. According to the parallel controlled principle,a contemporary cohort of 100 patients with isoimmune spontaneous recurrent abortion,who were not willing to be treated with lymphocyte injection,was included as the control group. The control group received lymphocyte injection and oral Dydrogesterone after successful pregnancy,and the study group was given lymphocyte injection at baseline,and oral Dydrogesterone after successful pregnancy. The abortion rate,number of patients with gestational age of 12 weeks,success rate of pregnancy,positive conversion rate of blocking antibody( BA),pregnancy outcomes of BA positive and negative patients were compared between the two groups. The levels of CD3 +,CD4 +,CD8 + and CD4 +/CD8 + T lymphocytes were compared at baseline and after the treatment. Results: After the treatment,ultrasonography showed that there were 300 cases of pregnancy. The number of abortion cases in the study group was significantly fewer than that in the control group,whereas the number of patients with gestational age of 12 weeks and successful pregnancy was significantly more than that in the control group( P<0.05). The BA positive conversion rate in the study group was significantly higher than that in the control group( P<0.01). The number of BA( +)patients undergoing abortion in the study group was significantly lower than that in the control group,whereas the number of BA( +) patients with gestational age of 12 weeks and successful pregnancy in the study group was more than that in the control group( P<0.05). In the study group,the levels of CD3+ and CD8+ T lymphocytes increased,whereas the CD4 + and CD4 +/CD8 + T lymphocytes decreased( P < 0. 05). The lymphocyte levels changed more significantly in the study group than those in the control group except for CD3 + T lymphocytes( P<0.05). Conclusion: Active immunization with injection of peripheral blood lymphocytes and oral Dydrogestrone before pregnancy is of great value in increasing the success rate of pregnancy,reducing the abortion rate, and improving maternal immune status in patients with isoimmune spontaneous recurrent spontaneous abortion.
作者
龙成英
徐珊珊
Long Chengying;Xu Shanshan(Department of Obstetrics and Gynecology,Dongguan Renkang Hospital,Dongguan,Guangdong 523952,China)
出处
《广州医科大学学报》
2018年第2期64-68,共5页
Academic Journal of Guangzhou Medical University
基金
东莞市医疗卫生一般项目(201610515001170)
作者简介
通讯作者:龙成英,Email:477796950@qq.com
