The Clinical Observation Of Recurrent Abortion Patients With The Change Of Before And After Immunization Therapy In The Rate Of T Lymphocyte Expression And Treatment Effect

Background:Recurrent spontaneous abortion (recurrent spontaneous abortion, RSA) refers tothe previous28weeks of pregnancy, three times in a row or three times morespontaneous abortions. Spontaneous abortion is the phenomenon that excludes humanfactors, for some reason due to the embryo or fetus separate from the motherautomatically. With the changes of the surrounding environment and lifestyle in ourcountry today, the incidence of recurrent spontaneous abortion increased year by year.There are many reasons result in RSA, the current can be broadly divided into twotypes of immune and non-immune. Non-immune factors include genetic factors(including chromosome abnormalities), anatomical structure malformations,infectionfactors, endocrine factors, microelement deficiencies, etc. Immune factors can bedivided into two categories: autoimmunity and isoimmunization type (also known asunknown type). Autoimmunity tape including anti-phospholipid antibodies (APA),anti-sperm antibodies (ASA), etc. T cells, NK cells have played an important role inisoimmunization tape.CD4+T lymphocyte subsets accounting for5%~10%T cellsin healthy human peripheral blood, natural regulatory T lymphocyte cells (nTreg)through direct contact between dependent cells, followed by the activation of TCR mediated signal, resulting in inhibition of CD4+and CD8+T lymphocyte cell activationand proliferation. CD3+、CD4+and CD8+are the main cellular componentproducedafter T lymphocyte activation, and useful indicator of clinical detection ofblocking antibody efficiency (i.e., T lymphocyte cell activation ratio), the lack ofblocking antibody can lead to fetal paternal antigens are identified and killed bymaternal immune system, nutrient cells of the embryo under immune attack resultingin abortion. In the peripheral blood of healthy women, a number of regulatory Tlymphocyte cells enable the mother play a protective role of immunosuppression tothe embryo that semi-allogeneic antigens, thereby inducing immune tolerance ofpregnancy; if the number of regulatory T lymphocyte cells in peripheral blooddecrease, maternal immune tolerance to the embryo will be reduced, so that theembryo subjected to immune attack, leading to miscarriage. Nowadays on the clinicaltreatment of RSA patients, blocking antibody negative result in recurrent miscarriagemost common treatment method is that lymphocyte immune therapy. Using theperipheral blood of patients’ husband or healthy male (the other person), aftercentrifuging use serum of male subcutaneous injection in patients, make the patientpassively produced autoimmune regulation, thereby increased the number ofregulatory T lymphocyte cells in peripheral blood induced the maternal producedimmune tolerance, when she conceived again can reduce the immune attack to theembryos half alloantigen antigens, therefor protecting the embryo, maintaining thepregnancy. In this paper, with the exclusion of patients with recurrent abortionanatomical factors known as uterine agenesis, bilateral tubal obstruction, vaginalagenesis etc; infectious factors known as mycoplasma, chlamydia, HPV etc, immunefactors known as anticardiolipin antibodies positive, antinuclear antibodies positive,antithyroid antibodies positive etc; male factors as male sexual dysfunction,congenital absence of sperm disorders; endocrine factors as polycystic ovarysyndrome, hyperthyroidism, premature ovarian failure, hyperprolactinemia all theseknown factors that affect pregnancy, by flow cytometry detecting T lymphocytesCD3+、CD4+and CD8+activation rate change values in peripheral blood of patientswith recurrent spontaneous abortion before and after active immunization treatment,learn more about the efficacy of immunotherapy, and further explore the blocking efficiency of T lymphocytes (CD3+、CD4+and CD8+) that value of diagnosis andtreatment in the clinical for RSA.Objective：1.To observe the blocking efficiency value changes of CD3+, CD4+and CD8+inrecurrent spontaneous abortion patients before and after immunotherapy in theperipheral blood and learn more about the effect of immunotherapy.2.By analyzing the blocking efficiency immunotherapy value of changes beforeand after T lymphocytes (CD3+, CD4+and CD8+) in peripheral blood before and therelationship between the pregnancy outcome, further discuss the value of diagnosisand treatment in RSA..Subjects and Methods:1Object of studyRSA patients300cases who accepted active immunotherapy for blocking antibodynegative in Third Affiliated Hospital of Zhengzhou University Reproductive Centerbetween October2010–October2012.In300cases, there were58cases gived uptreatment (due to personal reasons), lose to follow-up of60cases (for contact waychange), data effectively in statistical analysis of182cases.Aged36±10years old,26-36years old88cases,37-46years57cases.21cases of spontaneous abortion6times,34cases of spontaneous abortion5times,28cases of spontaneous abortion4times,62cases of spontaneous abortion3times.2MethodsFor patients with recurrent spontaneous abortion use double fluorescent markerflow cytometric analysis technique, use lymphocyte of patients’ husband (or unrelatedhealthy male) as antigen target, measured the blocking efficiency of T lymphocytes(CD3+、CD4+and CD8+) in peripheral blood of patients (if CD3+、CD4+and CD8+has a negative value, the diagnosis of blocking antibodies was negative, bring intothe therapeutic range). Detect the blocking efficiency of T lymphocytes (CD3+、CD4+and CD8+) in peripheral blood before and after treatment, observe and statistical analyze the result.3Statistical MethodsEncode the relevant variables and input Excel. Using statistical softwareSPSS17.0for statistical analysis, quantitative data is non-normal distribution, usingM (P25, P75) to describe, using rank sum test; comparison of qualitative data usingchi-square test. Test level α=0.05.Results:1. expression frequency of CD3+、CD4+and CD8+in peripheral blood ofblocking antibody negative patients with recurrent spontaneous abortion after activeimmunotherapy is significantly higher than before (P <0.05).2. In the182patients of treatment outcome the value of before and aftertreatment in not turned Yang with Yang’s patients CD3+、CD4+and CD8+is moresignificant differences (P <0.05), and turn to Yang in the peripheral blood of patientsafter treatment of CD3+、CD4+and CD8+value is significantly higher than patientswho were not turned Yang after treatment (P <0.05).3. There are37cases in182have pregnancy after treatment. There were133cases have not turned positive, of which were22cases pregnancy.49cases haveturned positive, of which were15cases pregnancy. Pregnancy rates of turned positivepatients and not turned positive patients were:31%,17%, P <0.05.Conclusion:1.Active immunotherapy can improve the blocking efficiency of CD3+, CD4+andCD8+in peripheral blood of recurrent spontaneous abortion patients there for helpingpregnancy.2.Betection of expression frequency of CD3+, CD4+and CD8+in peripheral bloodcan become an effective indicator of the efficiency of immunotherapy clinicalevaluation therefore has clinical value.