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目的 探讨血管生成性T细胞(Tang)及内皮祖细胞(EPC)与子痫前期发病的关系及两种细胞的相关性.方法 选取2013年3月至2014年8月在湖南省人民医院诊断为子痫前期的孕妇40例,其中轻度20例为子痫前期轻度组,重度20例为子痫前期重度组,另选取同期24例孕晚期健康孕妇作为健康孕妇组.采用流式细胞仪检测孕妇外周血浆中Tang和EPC的含量,对各组孕妇的临床指标和血浆中EPC和Tang的含量进行比较,并对Tang含量与EPC含量的相关性进行分析.结果(1)3组孕妇的年龄、孕前体质指数(BMI)、检测孕周分别比较,差异均无统计学意义(P>0.05).3组孕妇血压比较,差异均有统计学意义(P<0.05).子痫前期重度组孕妇分娩孕周、新生儿出生体质量和出生1分钟Apgar评分均明显低于子痫前期轻度组和健康孕妇组,分别比较,差异均有统计学意义(P<0.05).子痫前期重度组发生新生儿窒息7例(35%,7/20),子痫前期轻度组1例(5%,1/20),两组比较,差异有统计学意义(P<0.05).(2)健康孕妇组孕妇外周血浆中Tang含量为(52.7±8.0)%,子痫前期轻度组为(47.5±8.8)%,子痫前期重度组为(45.5±8.7)%,3组比较,差异有统计学意义(F=4.248,P<0.05);两两比较显示,子痫前期重度组低于健康孕妇组,差异有统计学意义(P<0.05),子痫前期轻度组与健康孕妇组及子痫前期重度组分别比较,差异无统计学意义(P>0.05).(3)健康孕妇组孕妇外周血浆中EPC含量为(0.16 ± 0.07)%,子痫前期轻度组为(0.09 ± 0.07)%,子痫前期重度组为(0.08 ± 0.05)%,3组比较,差异有统计学意义(F=9.351,P<0.05);子痫前期重度组和子痫前期轻度组均低于健康孕妇组,两者比较,差异有统计学意义(P<0.05).(4)健康孕妇组孕妇外周血浆中Tang含量与EPC含量无显著相关性(r=-0.325,P>0.05);子痫前期重度组和轻度组孕妇外周血浆中Tang含量与EPC含量有显著相关性(r=0.677,P<0.01).子痫前期轻度组外周血浆中Tang含量与EPC含量有显著相关性(r=0. 803,P<0.01);子痫前期重度组外周血浆中Tang含量与EPC含量有显著相关性(r=0.520,P<0.05).结论 孕妇外周血中Tang含量下降可能与子痫前期的发病有关;在子痫前期孕妇外周血中Tang含量与EPC含量呈正相关,Tang对EPC含量变化有明显的影响作用,两者共同参与子痫前期孕妇的血管内皮损伤的修复.

Objectives To investigate the role of angiogenic T cells (Tang) and endothelial progenitor cells (EPC) in the pathogenesis of preeclampsia. To explore the relationship between Tang and EPC. Methods From Mar 2013 to Aug 2014, 40 patients diagnosed preeclampsia (PE) and delivered in Hunan Provincial People′s Hospital. A total of 20 of them were defined as the mild preeclampsia group and the other 20 cases were recruited as the severe preeclampsia group. And 24 healthy pregnant women wererecruited as the control group. The percentage of Tang and EPC in peripheral blood mononuclear cells (PBMC) were determinated by flow cytometry between 28 and 40 gestational weeks. Results (1) There was no significant difference in the age, pre-pregnancy body mass index(Pre-BMI) or gestational age among the three groups (P>0.05). The differences of blood pressure among the three groups were statistically significant (P<0.05). The gestational week at delivery, the birthweight of the neonates and the 1 minute Apgar score in the severe preeclampsia group were lower than those in the mild preeclampsia group and the control group, with statistically significant differences (P<0.05). The morbidity of neonatal asphyxia in the severe preeclampsia group was 35%(7/20);and in the mild preeclampsia group it was 5%(1/20), with statistically significant difference( P<0.05). (2) The percentage of Tang in maternal peripheral blood was(52.7 ± 8.0)%, (47.5 ± 8.8)% and (45.5 ± 8.7)% in the control group, the mild preeclampsia group and the severe preeclampsia group, respectively. The difference among the three groups was significant (F=4.248,P<0.05), and SNK q analysis showed there was significant difference between the control group and the severe preeclampsia group(P<0.05).While there was no statistically significant difference between the mild and the severe preeclampsia group, nor between the control group and the mild preeclampsia group(P>0.05). (3) The percentage of EPC in maternal peripheral blood was (0.16±0.07)%, (0.09±0.07)%and (0.08±0.05)%in the control group, the mild and the severe preeclampsia group, respectively. Analysis of variance showed that difference among the three groups was significant (F=9.351, P<0.05). The percentage of EPC in the mild or the severe preeclampsia group was significantly higher than that of the control group(P<0.05). (4) There was no statistically significant correlation between the Tang level and the EPC level in the control group ( r=-0.325, P>0.05). In the preeclampsia group (including mild and severe cases), there was positive correlation between the Tang level and EPC level (r=0.667, P<0.01). The positive correlation between Tang level and EPC level were proved respectively in the mild preeclampsia group (r=0.803, P<0.01) and the severe preeclampsia group (r= 0.520, P<0.05). Conclusions The number of Tang had some correlation with the pathogenesis of preeclampsia. The percentage of Tang had positive correlation with the level of EPC in women with preeclampsia. Tang might have some influence on the change of EPC′ level. Tang together with EPC were likely to contribute to the angiogenesis in preeclampsia.