Correlation Between Peripheral Blood T Lymphocyte Subsets And PD-1 In Patients Of Premature Ovarian Insufficiency

Objective:By studying the correlation between estrogen levels of patients with premature ovarian insufficiency and peripheral blood lymphocyte subsets and the expression of programmed cell death-1（PD-1）,to investgate changes in immune function of patients with POI,and provide the basis of the clinical diagnosis,treatment and health management of POI.Methods:We analyzed patients in the gynecological clinic of Shanxi Maternal and Child Health Hospital from December 2019 to January 2021,patients between 28-40 years old were selected as the research objects.We definded 25 patients with the POI as study group,25healthy women as healthy group.The healthy group have any of the following conditions were included:normal menstrual cycle,normal levels of sex hormone and thyroid function,excluded:high testosterone level and polycystic ovary syndrome,autoimmune disease and recurrent spontaneous abortion.The study group were included:who has menopause more than 3 cycles or 6 months in the cyclic state,and hormone tested was FSH higher than 25 at least twice,interval more than 4 weeks.Excluded criteria:hepatorenal disease,immune system or endocrine system diseases,cancer,neither of patients received adjuvant radiotherapy/chemotherapy within five years,organic disease of gynecology,ovarian operation,treatment with hormone drugs in the past 3 months and acute infection within 2weeks.The level of estrogen and the expression of PD-1 on the CD4⁺T lymphocytes,CD8⁺T lymphocytes and CD4⁺and CD8⁺T lymphocytes in peripheral blood were compared between the healthy group and the study group to investigate whether E₂was correlated with the expression of PD-1 on the surface of T lymphocytes.Results:1.The levels of sex hormones in patients with POI were significantly different from those in normal women.The level of AMH was significantly decreased,while the FSH/LH was significantly higher than that in the healthy group,The difference in the two groups had a statistical significance（P<0.05）.2.Compared with the healthy group,the percentage of CD4⁺T cells in the study group decreased,and the percentage of CD8⁺T cells increased,the difference was statistically significant（P<0.05）.CD4⁺/CD8⁺was no significant difference between two groups.The percentage of PD-1 on T cell surface decreased,and the difference was statistically significant（P<0.05）.3.The correlation analysis between serum E2 level and CD4⁺T cell percentage in POI patients showed a positive correlation,and the differences were statistically significant（r=0.530,P<0.05）.There was no significant difference in the correlation between the percentage of CD8⁺T cells and the level of E₂（r=-131,P=0.363）.The expression of PD-1 on the surface of peripheral blood T cell subsets was positively correlated with serum E₂level,and the difference was statistically significant（r=0.415,P<0.05;r=0.437,P<0.05）,E₂was positively correlated with serum AMH level（r=0.589,P<0.05）,and had no correlation with serum TSH level（r=-0.265,P=0.063）.4.Age was negatively correlated with the percentage of CD4⁺T cells（r=﹣0.330,P<0.05）,and positively correlated with the percentage of CD8⁺T cells（r=0.295,P<0.05）.There is no correlation with the relative expression of PD-1 on the surface of CD4⁺and CD8⁺T cells（r=﹣0.268,P=0.060;r=﹣0.188,P=0.191）.There was a negative correlation between age and serum AMH level（r=﹣0.398,P<0.05）.It has a positive correlation with serum TSH level（r=0.350,P=0.013）.5.The serum TSH level was negatively correlated with the percentage of CD4⁺T cells and the expression of PD-1 on the surface of CD4⁺T cells and CD8⁺T cells in patients with POI（r=-0.400,P<0.05;r=-0.340,P<0.05;r=-0.352,P<0.05）,which was positively correlated with the percentage of CD8⁺T cells,and the difference was statistically significant（r=0.467,P<0.05）.Serum AMH level was negatively correlated with TSH level（r=-0.484,P<0.05）.6.The level of serum AMH in patients with POI was positively correlated with the percentage of CD4⁺T cells and the expression of PD-1 on CD4⁺T cells and CD8⁺T cells in peripheral blood T cell subsets（r=0.504,P<0.05;r=0.415,P<0.05;r=0.649,P<0.05）.There was positive correlation between CD8⁺T cell percentage and the difference was statistically significant（r=-0.430,P<0.05）.Conclusion:1.The levels of E₂,P and AMH in patients with POI were decreased,and FSH,LH and the ratio of FSH to LH were higher than those in normal women.2.Patients with POI had cellular immune disorder,the percentage of CD4⁺T cell subsets decreased,the percentage of CD8⁺T cell subsets increased,and the expression level of PD-1 on the surface of T lymphocytes was lower than that of normal women.3.Serum E₂level was positively correlated with CD4⁺T cell percentage,PD-1expression on T cell surface and serum AMH level.It indicated that the percentage of CD4⁺T cells and PD-1 expression on CD4⁺T cells and CD8⁺T cells were related to the decrease of E₂level in POI patients.4.Serum TSH level was correlated with the percentage of CD4⁺T cells and CD8⁺T cells in patients with POI.Thyroid function was correlated with immune system and hormone levels.