加味寿胎丸联合黄体酮调节NKG2D、NKG2A表达治疗肾虚型URSA作用机制研究
Study on the Action Mechanism of Combined Jiaweishoutai Wan and Progesterone in Regulating NKG2D and NKG2A Expression for Treating URSA of Kidney Deficiency Type
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摘要: 目的 探讨NK细胞活性变化在不明原因复发性流产（URSA）发病中的机制；加味寿胎丸联合黄体酮通过调节NK细胞受体表达变化诱导母胎免疫耐受治疗URSA的作用机制。方法 选取加味寿胎丸联合黄体酮治疗肾虚型URSA成功患者20例，并选取同期URSA妊娠丢失组及健康早孕（HEP）组各15例，以流式细胞术检测各组外周血NKG2D、NKG2A的表达，并比较URSA妊娠组治疗后与健康早孕组血E2、P、β-HCG水平。结果 URSA妊娠丢失组pNK细胞NKG2D呈高表达及NKG2A呈低表达，与HEP组比较有显著统计学意义（P＜0.01）。URSA妊娠组治疗后pNK细胞NKG2D表达水平明显低于治疗前，与HEP组比较有统计学意义（P＜0.05），与URSA妊娠丢失组比较有显著统计学意义（P＜0.01）；NKG2A表达水平明显高于治疗前（P＜0.01），与HEP组比较无统计学意义，与URSA妊娠丢失组比较有显著统计学意义（P＜0.01）。经加味寿胎丸联合黄体酮治疗后，URSA妊娠组血清E2、P、β-HCG水平与HEP组分别比较，差异均无统计学意义（P＞0.05）。结论 NK细胞受体NKG2D、NKG2A的表达参与了URSA的发病；加味寿胎丸联合黄体酮能通过下调URSA患者NKG2D的表达水平，上调NKG2A的表达水平介导母胎免疫耐受治疗URSA；固肾安胎法是治疗肾虚型URSA的有效方法，加味寿胎丸是治疗肾虚型URSA的有效方剂。Abstract: OBJECTIVE To investigate NK cells activity changes in the occurrence of URSA， and explain the action mechanism of combined Gushen Antai experienced formula "Jiaweishoutai Wan" and progesterone in the treatment of URSA by regulating expression changes of NK cell receptor to induce immune tolerance. METHODS Twenty patients with kidney deficiency type URSA successfully treated by combined Jiaweishoutai Wan and progesterone were chosen. And URSA pregnancy loss patients and HEP patients at the same period were selected， 15 cases in each group. The expression of NKG2D and NKG2A in peripheral blood were detected by flow cytometry. The levels of E2， P and β-HCG in the URSA pregnancy group and HEP group were compared after treatment. RESULTS In URSA pregnancy loss group， the expression of NKG2D of NK cells was higher and NKG2A was lower， the differences were statistically different compared with HEP group (P<0.01). NKG2D expression level of pNK cells in URSA pregnancy group was significantly lower than that of pretreatment， and the difference was statistically different compared with URSA pregnancy loss group (P<0.01); and the NKG2A expression level was obviously higher than that of pretreatment (P<0.01)， the difference was not statistically significant compared with HEP group， and the difference was statistically different compared with URSA pregnancy loss group (P<0.01). After treating with combined Jiaweishoutai Wan and progesterone， the blood serum E2， P and β-HCG levels in URSA pregnancy group were all not significantly different with that in the HEP group (P>0.05). CONCLUSION The expression of NK cells receptors including NKG2D and NKG2A is involving in the occurrence of URSA. The combined Jiaweishoutai Wan and progesterone can treat URSA by down regulating the NKG2D expression levels of URSA patients and up regulating NKG2A expression levels to induce maternal fetal immune tolerance. Gushen Antai method is an effective treating method for URSA of kidney deficiency type. Jiaweishoutai Wan is an effective formula for treating URSA of kidney deficiency type.
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