复发性流产慢性内膜炎患者内膜免疫细胞的变化

摘要

目的 观察复发性流产(RM)患者中慢性子宫内膜炎(CE)患者内膜免疫细胞表达的变化,以期探讨子宫内膜免疫平衡受损的机制. 方法 回顾性分析2015年10月至2017年2月在深圳中山泌尿外科医院生殖医学中心就诊的177例RM患者的临床资料,按照是否合并CE分为CE组和非CE组,于黄体中期取子宫内膜样本.免疫组化分析两组内膜CD138、CD56、CD8、Foxp3及CD68的表达情况,并运用Vectra(R)自动病理成像定量分析系统分别计算各阳性细胞占内膜总细胞的比例. 结果 RM患者中CE的发生率为10.2％.与非CE组比较,CE组子宫内膜CD56+ NK细胞和CD68+巨噬细胞比例无显著变化(P＞0.05),而CD8+T细胞比例[(6.29±4.26)％ vs.(3.45±1.79)％,P=0.003]和Foxp3+ Treg细胞比例[(0.18±0.86)％vs.(0.11±0.75)％,P＜0.001]显著增高. 结论 在RM人群中,CE可能导致子宫内膜CD8+T细胞和Foxp3+ Treg细胞比例上调,但其具体的分子机制还需进一步研究.%Objective:To observe the changes of endometrial immune cells in patients with chronic endometritis (CE) and recurrent miscarriage(RM),and explore the mechanism of endometrial immune unbalance induced by chronic endometritis.Methods:The clinical data of 177 patients with RM in Shenzhen Zhongshan Urology Hospital from October 2015 to February 2017 were retrospectively analyzed.According to whether concurrent CE,the patients were divided into CE group and non-CE group.The endometrial samples were taken in the middle of luteal phase.CD138,CD56,CD8,Foxp3 and CD68 were identified by immunohistochemistry in endometrial samples from the patients.The percentages of CD56+,CD8+,Foxp3+ and CD68+ cells were measured by Vectra(R) automatic pathological imaging quantitative analysis system.Results:The prevalence of CE in RM patients was 10.2％.Compared to non-CE group,the numbers of CD56+ natural killer cells and CD68+ macrophages were not significantly changed (P＞ 0.05).The proportions of CD8+ T cells [(6.29 ± 4.26)％ vs.(3.45 ± 1.79)％,P =0.003] and Foxp3+ Treg cells [(0.18±0.86) ％ vs.(0.11±0.75)％,P＜0.001)] in CE group were significantly increased compared with non-CE group.Conclusions:In RM patients with CE,the proportions of endometrial CD8+T and Foxp3+ Treg cells were significantly increased.However,the molecular mechanism of endometrial immune unbalance induced by CE needs further investigation.