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反复胚胎种植失败免疫治疗疗效及淋巴细胞免疫表型变化的研究
陈丹;刘仲伟;陈慧;孟昱时;
0
(昆明医科大学第二附属医院;昆明医科大学第一附属医院)
摘要:
目的:探讨淋巴细胞主动免疫治疗不明原因反复胚胎种植失败(RIF)患者的疗效及治疗前后外周血淋巴细胞免疫表型的变化。方法:对研究组83例不明原因RIF的患者进行淋巴细胞主动免疫治疗(LIT);对照组96例不明原因RIF患者移植前不给予特殊处理。并按照胚胎移植属性分为鲜胚移植和冻胚移植,所移植胚胎均为卵裂期优质胚胎,接受LIT后新鲜胚胎移植为研究组A(51例);未行LIT接受新鲜胚胎移植为对照组A(57例)。接受LIT后冷冻胚胎移植为研究组B(32例),未行LIT接受冷冻胚胎移植为对照组B(39例)。比较各组的临床妊娠情况,并观察LIT治疗前后外周血淋巴细胞免疫表型变化。结果:(1)研究组A的临床妊娠率(47.06%)高于对照组A(22.81%),研究组B的临床妊娠率(46.88%)高于对照组B(23.77%),差异有统计学意义(P<0.05);研究组A的临床妊娠率与研究组B比较,差异无统计学意义(P>0.05)。(2)与治疗前相比,LIT后外周血CD3~+CD4~+T细胞占淋巴细胞的比率下降,CD3~+CD8~+T细胞占淋巴细胞的比率上升、CD4~+/CD8~+比值下降,NK细胞(CD3-CD16~+CD56~+)占淋巴细胞的比率下降,差异均有统计学意义(P<0.05)。结论:淋巴细胞主动免疫治疗对RIF患者成功妊娠有促进作用,淋巴细胞主动免疫治疗可能促使外周血淋巴细胞免疫表型向增强母胎免疫耐受的方向改变。
关键词:  反复胚胎种植失败  临床妊娠率  淋巴细胞主动免疫治疗  淋巴细胞免疫表型
DOI:
基金项目:云南省科技厅-昆明医科大学应用基础研究专项资金项目[编号:2017FE467(-181)]
Study on the Effect of Lymphocyte Immunotherapy and the Change of Lymphocyte Immunophenotyping in Repeated Implantation Failure
CHEN Dan;LIU Zhongwei;CHEN Hui;MENG Yushi
(The Second Affiliated Hospital of Kunming Medical University;First Affiliated Hospital of Kunming Medical University)
Abstract:
Objective:To investigate the efficacy of active immunotherapy of lymphocytes in patients with unexplained recurrent embryo implantation(RIF) and the changes of lymphocyte immune phenotype in peripheral blood before and after treatment.Methods:Lymphocyte active immunotherapy(LIT) was performed in 83 patients with unexplained RIF in the study group.96 patients with unexplained RIF in the control group were not treated with special treatment before transplantation.And embryos were divided into fresh embryo and frozen embryo.The embryos were all high-quality embryos of the cleavage stage.After the LIT,the fresh embryo was transplanted into the study group A(51 cases).Fresh embryo transfered without LIT as control Group A(57 cases).LIT was treated with frozen embryos for study group B(n = 32) and frozen embryo transfered without LIT in control group B(n =39).The clinical pregnancy status of each group was compared and the immunophenotypic changes of peripheral blood lymphocytes were observed before and after LIT treatment.Results:(1)The clinical pregnancy rate(47.06%)in study group A was higher than that in control group A(22.81%),and the clinical pregnancy rate(46.88%) in study group B was higher than that in control group B(23.77%)(P<0.05);there was no significant difference on the clinical pregnancy rate between study group A and study group B(P>0.05).(2) Compared with before treatment,the ratio of CD3~+CD4~+T cells to lymphocytes in peripheral blood decreased after LIT treatment,the ratio of CD3~+CD8~+T cells to lymphocytes increased,CD4~+/CD8~+ratio decreased,NK cells(CD3-CD16~+CD56~+) on lymphocytes decreased,all the differences were statistically significant(P <0.05).Conclusions:Active immunotherapy of lymphocytes can promote the successful pregnancy of patients with RIF.Active immunotherapy of lymphocytes may promote the immune phenotype of peripheral blood lymphocytes to enhance the direction of maternal immune tolerance.
Key words:  Repeatedimplantationfailure  Pregnancyrate  Lymphocyteimmunotherapy  Lymphocyteimmunophenotyping

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