| ObjectiveIncidence of Recurrent spontaneous abortion (RSA) is 1%～2% of the women of childbearing age。RSA is a sproblem to be solved urgently in the refractory infertility, and has unknown reason in 60%～70%(URSA group)。Recent research suggests that the immunological factor is one of the important reasons。 Natural killer (NK) cells is an important immune cells, including CD56+CD16- subgroups of main immune regulating role。 Pregnancy associated protein A (PAPP-A) is an immunosuppressive factors, which produced in fit trophoblast cells and decidual cells。Detecting peripheral blood NK cell CD56+CD16- subgroup and PAPP-A levels of URSA group and analyzing the correlation with URSA to provide important theoretical basis for finding and developing new treatment plans of URSA。MethodUsing flow fluid cytology examination technology and enzyme-linked immunosorbent (ELISA) to detect peripheral blood NK cell CD56+CD16-subgroup and PAPP -A levels of URSA group、clear recurrent spontaneous abortion (CRSA group) and normal early pregnancy (NEP group)。ANOVA is used to analyze the significance of difference and Speaman is used to analyzing the correlation with NK cells CD56+CD16" subgroup percentage and PAPP-a levels。Result1.Peripheral blood NK cell percentage of lymphocyte:URSA group (13.77±1.53)%, CRSA group (13.97±1.60)%, NEP group (13.65±1.74) %。There was no statistically significant difference comparing three groups(F=0.287, P=0.751>0.05)。2.Peripheral blood NK cell subgroup percentage:2.1CD56+CD 16-:Three groups have homogeneity of variance and comparing differences between three groups have significant statistical significance (F= 182.587, P=0.000<0.05)。Pairwise comparison between three groups:URSA group has significant difference compared with CRSA group of statistical significance (P=0.000 <0.05); URSA group has significant difference compared with NEP group statistical significance (P=0.000<0.05); CRSA group has was no statistically significant difference compared with NEP group (P=0.508> 0.05)。2.2 CD56+CD16+:Three groups have homogeneity of variance and comparing differences between three groups have significant statistical significance (F=126.534, P=0.000<0.05)。Pairwise comparison between three groups:URSA group has significant difference compared with CRSA group of statistical significance (P=0.000 <0.05); URSA group has significant difference compared with NEP group statistical significance (P=0.000<0.05); CRSA group has was no statistically significant difference compared with NEP group (P=0.452>0.05)。 2.3 CD56-CD16+:Three groups have homogeneity of variance and comparing differences between three groups have significant statistical significance (F=56.879, P=0.000<0.05)。Pairwise comparison between three groups:URSA group has significant difference compared with CRSA group of statistical significance (P=0.000 <0.05); URSA group has significant difference compared with NEP group statistical significance (P=0.000<0.05); CRSA group has was no statistically significant difference compared with NEP group (P=0.240>0.05)=3. Peripheral blood PAPP -A,β-HCG and P levels:3.1 The level of PAPP-A:Three groups have homogeneity of variance and comparing differences between three groups have significant statistical significance (F=182.587, P=0.000<0.05)。Pairwise comparison between three groups:URSA group has significant difference compared with CRSA group of statistical significance (P=0.000<0.05); URSA group has significant difference compared with NEP group statistical significance (P=0.000<0.05); CRSA group has was no statistically significant difference compared with NEP group (P=0.508>0.05)。3.2 The level of P-HCG:Three groups have homogeneity of variance and comparing differences between three groups have significant statistical significance (F=56.534, P=0.000<0.05)。Pairwise comparison between three groups:URSA group has significant difference compared with CRSA group of statistical significance (P=0.005<0.05); URSA group has significant difference compared with NEP group statistical significance (P=0.000<0.05); CRSA group has was statistically significant difference compared with NEP group (P=0.000<0.05)。3.3 The level of P:Three groups have homogeneity of variance and comparing differences between three groups have significant statistical significance (F=157.636, P=0.000<0.05)。Pairwise comparison between three groups:URSA group has no significant difference compared with CRSA group of statistical significance (P=0.155 >0.05); URSA group has significant difference compared with NEP group statistical significance (P=0.000< 0.05); CRSA group has was statistically significant difference compared with NEP group (P=0.000<0.05)。4. Correlation analysis of CD56+CD16-percentage and PAPP -A level:Pearson correlation analysis of peripheral blood PAPP -A, CD56+CD 16-in URSA group (r= 0.853); Pearson correlation analysis of peripheral blood PAPP -A, CD56+CD16-in CRSA group (r= 0.973); Pearson correlation analysis of peripheral blood PAPP -A, CD56+CD16-in NEP group (r= 0.922). This shows that PAPP-A has positively correlation with CD56+CD 16-。ConclusionBy comparing NK cells of lymphocyte percentage (P>0.05), it shows that there are no significant differences of peripheral blood NK cell level in the CRSA group, URSA group and the NEP group。 Peripheral blood NK cell CD56+CD 16+subgroup percentage of URSA group is significantly higher than the CRSA group,and the NEP group, which shows that enhanced immune killing embryos caused miscarriage because of the NK cells higher activity in URSA group patients。NK cell activity function played a key role in the URSA group。Checking the NK cells percentage helps examination of RSA women during pregnancy。NK cells subgroup percentage change can predict the pregnancy outcome。By comparing peripheral blood PAPP-A level in the CRSA group, URSA group and the NEP group, there are differences in URSA group with CRSA group。This illustrates the PAPP-A is an important part of the immune factors in the pathogenesis in the URSA group。There are differences in CRSA group with NEP group, which illustrates CRSA group can also be caused by abnormal immune, but not the main reason。Adverse pregnancy outcomes were found in the low P and lowp-HCG levels, the low level of PAPP-A consistent with low levels of β-HCG trend, which shows peripheral blood PAPP-A level can predict the pregnancy outcome。PAPP-A, P, and β-HCG has certain clinical value in the early diagnosis and treatment of RSA. Especially a low level of PAPP-A in URSA group patients with A, which provid theoretical basis to improve the pregnancy outcome for immunological treatment.Correlation analysis of CD56+CD16-percentage and PAPP -A level shows there was no statistically significant difference of URSA group。 But the low level of PAPP -A and the low percentage of CD56+CD16-are converged。CD56+CD16-percentage and PAPP-A level were positively correlated of CRSA group and NEP group show that PAPP-A and CD56+CD16-play a synergistic effect in RSA pathogenesis。The main reason for the CRSA group is embryonic chromosomal abnormalities o Peripheral blood CD56+16-percentage can be used as a chromosome normal pregnancy occur biochemical predictors of pregnancy and abortion。Spontaneous abortion patients with normal CD56+16-percentage and lower PAPP-A may exist chromosomal abnormalities。 In conclusion, NK cells subgroup percentage and PAPP-A level can predict the pregnancy outcome, and they play a synergistic effect in the mechanism of RSA, providing important theoretical basis from the perspective of immunological regulating peripheral blood NK cell CD56 +CD16-subgroup percentage and/or the use of recombinant PAPP-A preparation to treat URSA。... |
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