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目的:探讨原因不明复发性自然流产(URSA)患者的心理健康状况及心理干预对其免疫功能和治疗效果的影响。方法:采用症状自评量表(SCL-90)对142例URSA患者和102例正常妇女进行心理状况调查,URSA患者知情选择分为淋巴细胞主动免疫组、心理干预联合黄体酮组和单纯黄体酮组,并用双抗体夹心酶联免疫吸附法检测治疗前、后Th1(IFN-γ、TNF-α)和Th2(IL-4、IL-10)细胞因子水平,并观察妊娠结局。结果:URSA患者SCL-90自评总分、总均分、抑郁、人际关系敏感因子均高于正常对照组(P<0.05);治疗前URSA患者IFN-γ、TNF-α水平高于正常对照组(P<0.05),IL-4水平低于正常对照组(P<0.05)。主动免疫治疗后IFN-γ、TNF-α水平降低(P<0.05),IL-4和IL-10水平升高(P<0.05);心理干预联合黄体酮治疗后IFN-γ、TNF-α水平降低(P<0.05)。随访至足月分娩,主动免疫组、心理干预联合黄体酮组和黄体酮组妊娠成功率分别为85.71%(54/63)、83.67%(41/49)和73.33%(22/30),黄体酮组的妊娠成功率低于其他两组(P<0.05)。结论:反复自然流产可以影响妇女的正常心理活动,较差的心理状态干扰机体免疫功能,适当心理干预可调整机体免疫功能,提高治疗效果,有临床应用价值。
Objective: To investigate the mental health of patients with unexplained recurrent spontaneous abortion (URSA) and the effect of psychological intervention on their immune function and therapeutic effect. Methods: The psychological status of 142 URSA patients and 102 normal women were investigated by SCL-90. The informed choice of URSA patients was divided into three groups: active lymphocyte immunization, psychological intervention combined with progesterone and progesterone The levels of Th1 (IFN-γ, TNF-α) and Th2 (IL-4, IL-10) cytokines were measured before and after treatment with double antibody sandwich enzyme-linked immunosorbent assay. Pregnancy outcomes were observed. Results: The scores of SCL-90 self-rated total score, total score, depression and interpersonal sensitivity in URSA patients were higher than those in normal controls (P <0.05). The levels of IFN-γ and TNF-α in URSA patients before treatment were higher than those in normal controls Group (P <0.05), IL-4 level was lower than the normal control group (P <0.05). After active immunotherapy, the levels of IFN-γ and TNF-α were decreased (P <0.05) and the levels of IL-4 and IL-10 were increased (P <0.05) Decreased (P <0.05). The success rates of pregnancy in active immunization group, psychological intervention combined with progesterone group and progesterone group were 85.71% (54/63), 83.67% (41/49) and 73.33% (22/30), respectively, The success rate of pregnancy in ketones group was lower than the other two groups (P <0.05). CONCLUSIONS: Repeated spontaneous abortion can affect the normal psychological activities of women. The poor mental state interferes with the immune function of the body. Appropriate psychological intervention can adjust the immune function and improve the therapeutic effect, which has clinical value.