Abstract:

Objective To investigate the changes of follicular helper T lymphocytes （Tfh） in peripheral blood of the patients with systemic lupus erythematosus （SLE） during pregnancy， and to clarify the immune effects of Tfh cells duing pregnancy. Methods The SLE patients from Qingdao Municipal Hospital and Qingdao Women and Children Hospital were divided into SLE with pregnancy group （n=32） and SLE without pregnancy group （n=30）；at the same time， healthy pregnancy group （healthy pregnancy women，n = 30） and healthy non-pregnancy group（healthy non-pregnancy women，n=25） were used as control. According to the changes of lupus during pregnancy and after termination of pregnancy within 3 months， the 32 cases of SLE patients in SLE with pregnancy group （2 cases were lost during follow-up） were divided into poor prognosis group（n=8） and clinical stabilization group（n=22）. The clinical data and laboratory examination indexes of the patients were collected. The percentages of CD4+inducible T-cell costimulatory factor （ICOS）+ chemokine C-X-C-motif receptor 5（CXCR5）+Tfh cells in the CD4+ T lymphocytes in peripheral blood of the patients in various groups（ percentages of Tfh cells ） were detected by flow cytometry. The relationships between the percentages of Tfh cells in peripheral blood of the patients in SLE with pregnancy group and the laboratory examination indexes were analyzed by Spearman correlation analysis.The levels of interleukin-6 （IL-6）， interleukin-21 （IL-21） and interferon-γ （IFN- γ） in peripheral blood of the subjects in various groups were detected by enzyme linked immunosorbent assay（ELISA）method. Results Compared with healthy pregnancy group， the percentage of Tfh cells in peripheral blood of the patients in SLE with pregnancy group was significantly increased（P<0.01）， and the percentage of Tfh cells in peripheral blood of the subjects in healthy non-pregnancy group was significantly decreased（P<0.05）. Compared with SLE without pregnancy group， the percentage of Tfh cells in peripheral blood of the patients in SLE with pregnancy group was significantly increased（P<0.05）. During the follow-up， compared with clinical stabilization group， the percentage of Tfh cells in peripheral blood of the patients in poor prognosis group was significantly increased（P<0.05）. The percentage of Tfh cells in peripheral blood of the patients in SLE with pregnancy group was positively correlated with the levels of anticardiolipin antibody （ACA） and anti-β2 glycoprotein Ⅰ（β2GPⅠ） antibody（r=0.743 1，P<0.05； r=0.830 7，P<0.01）. Compared with healthy pregnancy group， the levels of IL-6 and IL-21 in peripheral blood of the patients in SLE with pregnancy group were significantly increased（P<0.05）；compared with SLE without pregnancy group，the level of IL-21 in peripheral blood of the patients in SLE with pregnancy group was significantly increased（P<0.05）. Conclusion The increase of the percentage of Tfh cells in peripheral blood of the patients with SLE in early pregnancy may be related to the poor pregnancy prognosis in the patients with SLE.

Key words: Follicular helper T lymphocytes, Systemic lupus erythematosus, Pregnancy, Prognosis