CAJ | 학술논문

目的探讨单纯静脉注射免疫球蛋白(IVIG)被动免疫治疗及淋巴细胞主动免疫(LIT)联合静脉注射免疫球蛋白(IVIG)被动免疫治疗对复发性流产患者的治疗效果及对其免疫状态的影响.方法临床确诊为封闭抗体阴性复发性流产患者124例,随机平均分为两组:A组仅接受IVIG,B组接受LIT及IVIG联合治疗,比较两组患者封闭抗体转阳率,临床妊娠率,患者血清淋巴细胞亚群CD3+、CD4+、CD8+水平、CD4 +/CD8+比率及细胞因子IFN-γ、IL-10水平和NK细胞含量的变化.结果免疫治疗后,A组封闭抗体转为阳性者45例(72.58％)、B组封闭抗体转为阳性者58例(93.55％),两组之间差异有统计学意义(X2 =9.688,P＜0.05);两组成功妊娠率为A组妊娠39例(62.90％),B组妊娠51例(82.26％),两组之间差异有统计学意义(X2 =5.835,P＜0.05).接受免疫治疗后B组与A组比较,CD3+细胞百分比较治疗前升高,有统计学意义(t=2.497,P＜0.05);CD4+细胞百分比降低(t=4.514,P＜0.05);CD8+细胞百分比升高(t=21.697,P＜0.05);CD4+/CD8+比率降低(t=2.146,P＜0.05),IFN-γ水平降低(t=4.514,P＜0.05),IL-10则升高(t=21.697,P＜0.05);外周血NK细胞百分比下降(t=2.146,P＜0.05),B组变化幅度均高于A组,差异具有统计学意义.结论封闭抗体阴性复发性流产患者接受免疫治疗能改善体内细胞免疫状态,具有较好的疗效,LIT联合IVIG治疗较单独应用IVIG效果更好.
목적 탐토단순정맥주사면역구단백(IVIG)피동면역치료급림파세포주동면역(LIT)연합정맥주사면역구단백(IVIG)피동면역치료대복발성유산환자적치료효과급대기면역상태적영향.방법 림상학진위봉폐항체음성복발성유산환자124례,수궤평균분위량조:A조부접수IVIG,B조접수LIT급IVIG연합치료,비교량조환자봉폐항체전양솔,림상임신솔,환자혈청림파세포아군CD3+、CD4+、CD8+수평、CD4 +/CD8+비솔급세포인자IFN-γ、IL-10수평화NK세포함량적변화.결과 면역치료후,A조봉폐항체전위양성자45례(72.58％)、B조봉폐항체전위양성자58례(93.55％),량조지간차이유통계학의의(X2 =9.688,P＜0.05);량조성공임신솔위A조임신39례(62.90％),B조임신51례(82.26％),량조지간차이유통계학의의(X2 =5.835,P＜0.05).접수면역치료후B조여A조비교,CD3+세포백분비교치료전승고,유통계학의의(t=2.497,P＜0.05);CD4+세포백분비강저(t=4.514,P＜0.05);CD8+세포백분비승고(t=21.697,P＜0.05);CD4+/CD8+비솔강저(t=2.146,P＜0.05),IFN-γ수평강저(t=4.514,P＜0.05),IL-10칙승고(t=21.697,P＜0.05);외주혈NK세포백분비하강(t=2.146,P＜0.05),B조변화폭도균고우A조,차이구유통계학의의.결론 봉폐항체음성복발성유산환자접수면역치료능개선체내세포면역상태,구유교호적료효,LIT연합IVIG치료교단독응용IVIG효과경호.
Objective To investigate clinical effect and immune status of intravenous immune globulin (IVIG) alone or in combination with lymphocyte active immunotherapy (LIT) for treatment of unexplained recurrent spontaneous abortion patients.Methods 124 patients diagnosed with recurrent spontaneous abortion were randomly assigned into two groups for equal numbers.Group A patients ( n =62) were treated with IVIG;while group B ( n =62) received IVIG and LIT combination treatment.Efficacy was assessed by measurements of blocking antibody (BA) positive rate,the clinical pregnancy rate and lymphocyte subsets levels:CD3 + T cells,CD4 + T cells CD8 + T cells,as well as levels of IFN-γ,IL-10 and NK cell.Results Mter Immune treatment,significant difference in BA was found between two groups with 45 cases (62.90％) in group A,and 58 cases (93.55％)in group B ( X 2 =9.688,P ＜ 0.05 ).Significant difference was also found in clinic pregnancy rate (X 2 =5.835,P ＜0.05):39 cases(62.90％ ) in group A vs.51 cases(82.26％ ) in group B.There was statistical significance in the percentage of CD3 + between group A and group B ( t =2.494,P ＜ 0.05 )before and after Immune treatment.However,compared with A group,the percentage of CD4+T cell was more decreased and the percentage of CD8 + T cell was more increased in group B ( t =4.514,t =21.697,P ＜0.05,respectively);CD4 +/CD8 + ratio and IL-10 level and NK cell percentage were more decreased in group B( t =2.146,t =21.697,t =2.146,P ＜0.05 respectively) ;the level of IFN-γ was more increased in group B( t =4.514,P ＜0.05).There is a statistical significance on these items,in which group B is higher than group A.Conclusions Immune treatment may act as an effective and safe method for treatment of recurrent spontaneous abortion patients with negative BA.In addition,combination therapy with LIT and IVIG was more effective than IVIG alone.