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目的探讨淋巴细胞主动免疫治疗(LIT)结合心理干预对复发性流产(RSA)患者封闭抗体(BA)水平及妊娠结局的影响。方法选取2014年1月至12月收治的RSA患者88例,采用随机数字表法分为治疗组和对照组,各44例。两组均进行LIT,治疗组同时进行心理干预治疗。检测并比较两组治疗前后患者BA及血清细胞因子水平变化,采用症状自评量表(SCL-90)对两组进行心理状况调查,并统计治疗后妊娠结局。结果治疗后治疗组BA转阳率95.45%,对照组为88.64%,两组BA转阳率相近(P>0.05)。与治疗前比较,治疗3个疗程后两组CD3~+、CD4~+、CD8~+T淋巴细胞的封闭效率(BE)均有所升高(P均<0.01),但两组间比较差异无统计学意义(P均>0.05)。治疗3个疗程后两组血清肿瘤坏死因子-α(TNF-α)、干扰素(IFN)-γ水平降低,白细胞介素(IL)-4、IL-10水平升高,但两组间比较差异无统计学意义(P均>0.05)。与治疗前比较,治疗后治疗组强迫症状因子、人际关系敏感因子、抑郁因子、焦虑因子评分均有明显降低(P均<0.01),且显著低于对照组(P均<0.01)。治疗组治疗成功率93.18%与对照组的88.64%比较无统计学差异(P>0.05)。结论 LIT及LIT联合心理干预治疗对RSA患者治疗效果均显著,LIT联合心理干预可同时改善患者的心理健康状况,有利于提高BA转阳率及T淋巴细胞BE水平,能否提高患者的成功分娩率有待扩大样本量进一步研究。
Objective To investigate the effect of active immunotherapy with lymphocytes (LIT) and psychological intervention on the level of anti-HBs and pregnancy outcomes in patients with recurrent spontaneous abortion (RSA). Methods Eighty-eight patients with RSA admitted from January 2014 to December 2014 were randomly divided into treatment group and control group, with 44 cases in each group. Both groups were LIT, treatment group psychological intervention at the same time. The levels of BA and serum cytokines in patients before and after treatment were detected and compared. The psychological status of both groups were investigated by SCL-90, and the pregnancy outcomes after treatment were calculated. Results After treatment, the positive rate of BA was 95.45% in the treatment group and 88.64% in the control group, and the positive rate of BA was similar in both groups (P> 0.05). Compared with those before treatment, the sealing efficiency (BE) of CD3 +, CD4 +, CD8 + T lymphocytes in both groups increased after three courses of treatment (all P <0.01), but there was significant difference between the two groups No statistical significance (P> 0.05). After 3 courses of treatment, the level of serum tumor necrosis factor-α (TNF-α) and interferon (IFN) -γ were decreased and the levels of interleukin (IL) -4 and IL-10 were increased in both groups The difference was not statistically significant (P> 0.05). Compared with those before treatment, the scores of obsessive-compulsive disorder, interpersonal sensitivity, depression and anxiety in the treatment group were significantly decreased (all P <0.01), and significantly lower than those in the control group (all P <0.01). The treatment success rate of 93.18% in the treatment group and 88.64% in the control group showed no significant difference (P> 0.05). Conclusions LIT and LIT combined with psychological intervention have significant therapeutic effect on patients with RSA. Combined LIT and psychological intervention can improve the mental health status of patients, improve the transfusion rate of BA and the level of BE of T lymphocytes, and improve the success of delivery Rates need to be expanded for further study.