| Object: Abortion refers to pregnancy was terminated less than 28 weeks, fetal weight less than 1000 g, and early abortion means that pregnancy was terminated less than 12 weeks, late-term abortion refers to occur after 12 weeks. Spontaneous abortion is a common disease during early pregnancy, and its etiology and mechanism is very complex, besides common factors like anatomical anomalies(such as uterine malformation, cervical incompetence), chromosome abnormalities, genetic, endocrine, physical and chemical and infectious, reproductive immunity becomes one of the hot research spots in recent years, and also has related researches show that the immune factors closely associated with spontaneous abortion. The theory is that, from the point of the transplantation immunology, why the embryo as allogeneic grafts with "foreign" antigens can exist in mater, is because of the delicate and complex immune system regulation on maternal fetal interface. Many factors can change the distribution levels of a variety of active factors on maternal fetal interface by activating Toll-like receptors in mater, destroy the balance of immune system on maternal fetal interface, and make embryo be rejected by the mater’s immune response, causing miscarriage in the end. TLRs, which is a kind of pattern molecular that can identify pathogenic microorganisms, has regulative function of the innate and acquired immunity, and participate in the resistance of original microbial by natural immune response on maternal fetal interface. Not only do TLRs express in immune active cells, but also in other parts, such as villi trophoblast cells and decidua, and its affection of maintain healthy pregnancy and spontaneous abortion cannot be ignored. At present, the study of toll-like receptor 2 and 4 are more in known researches that explore TLRs associated with abortion.TLR2 and TLR4 are very important protein in body’s natural immune system, and they are also the characteristic receptors in the family of TLRs. They distribute on most cell membranes, especially the distribution level of marrow mononuclear cells in bone is the highest, and the distribution level is more on cell membrane of neutrophils, macrophages, dendritic cells, in addition, they also distribute in myocardial cells, microvascular endothelial cells, airway epithelial cells, fat cells, epithelial cells of the digestive tract, human embryonic kidney cells, gingival fibroblasts, human skin, umbilical vein endothelial cells and trophoblast cells. Toll-like receptor 2 recognizes peptidoglycan, and toll-like receptor 4 recognizes lipopolysaccharide, endotoxin, etc., and they infect the balance of Th1/Th2 by activating factors on maternal fetal interface through the reaction of transduction path by dependence and independence myeloid differentiation protein 88(My D88). Th1 produces excessive chemokines whose cytotoxic effect on trophoblast cells to cause immune injury, which directly or indirectly affect the implantation and growth of embryo; while Th2 played an important role of immune protection on maternal fetal surface. So, when the balance of Th1/Th2 bias Th1, it will increase the risk of pathological pregnancy. If the patients with spontaneous abortion blindly take actions to protect fetus, rather than for etiological treatment, often cannot achieve expected result of doctors and patients. So some measures that as much as possible to analyze and find the pathogenesis become important. This article is exploring the correlation between distribution level and spontaneous abortion through comparing the expression of toll-like receptors 2 and 4 in villi and peripheral blood.Methods: Chosen on clinic patients in the department of obstetrics and gynecology in 105 th hospital of PLA during June 2014 to December 2014(age<35 years of age, gestational age<12 weeks) as the research objects of this experiment: the pregnancy outcome is spontaneous abortions; healthy pregnant women who are by reason of accidental pregnancy and want to terminate pregnancy by artificial abortion.The objects of study are carried out by specialist on history information, including past medical history, history of menstruation, examination history, family history, etc., and verify whether true and accurate about the filled projects. Physical examination including: general physical examination, blood pressure, height, weight, thyroid, breast, etc., and regular examination of department of obstetrics and gynecology. All objects are examined foundation level of sex hormone, B ultrasonic examination, couples chromosome examination, whether has acute or chronic infectious diseases, inflammation of department of obstetrics and gynecology and the immune antibody associated with pregnancy(such as anti-phospholipid antibodies, anti-beta 2 glycoprotein antibodies, anti-nuclear antibodies, anti-thyroid antibodies and lupus anticoagulant factors for positive) and other auxiliary examination, and as much as possible to eliminate factors related to heredity, chromosome, anatomy.The pregnancy outcomes of patients with spontaneous abortion as one group, and the healthy pregnant women who are by reason of accidental pregnancy and want to terminate pregnancy by artificial abortion as the other one group. Each group has 20 cases.Using immunohistochemistry to check the distribution of TLR2 and TLR4 in villi trophoblast cells of each patient(each sample randomly selected one microscope slide, the judgment standard is to see whether the villi trophoblast cells contains tan particles). Using average standard deviation for analysis by statistical software of SPSS 17.0.Results: 1. The difference of patient’s age, gestational age and pregnant time between spontaneous abortion group and control group had no statistical significance.2. TLR2 and TLR4 were both seen in villi trophoblast cells in spontaneous abortion group and control group, mainly distributing in syncytiotrophoblast. The difference of TLR2 whose distribution in villi trophoblast cells,peripheral blood mononuclear cells and granulocyte group between spontaneous abortion group and control group had no statistical significance(P>0.05), the difference of TLR2 whose distribution in peripheral blood lymphocytes between spontaneous abortion group and control group had statistical significance(P<0.05).3.The difference of TLR4 whose distribution in villi trophoblast cells, peripheral blood mononuclear cells, granulocyte group and lymphocytes between spontaneous abortion group and control group had statistical significance(P<0.05).Conclusions: 1. TLR2 and TLR4 distribute in villi trophoblast cells, peripheral blood lymphocytes, mononuclear cells and granulocyte group in both groups.2.The distribution level of TLR2 in peripheral blood lymphocytes in patients with spontaneous abortion increases significantly.3. The distribution level of TLR4 in villi trophoblast cells, peripheral blood mononuclear cells, granulocyte group and lymphocytes in patients with spontaneous abortion increased significantly, so TLR2 and TLR4 might be one of the key links in the occurrence of spontaneous abortion.4. TLR4 might be causing spontaneous abortion by influencing the balance of Th1/Th2. |
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