[Chinese Herbs Combined Three-stage Sequential Therapy for Conservative Treatment of Ectopic Pregnancy].

Objective To observe the clinical efficacy and safety of three-stage sequential thera- py [(methotrexate + mifepristone + Gongwaiyun Recipe (GR)] for conservative treatment of ectopic pregnancy. Methods Recruited were 250 ectopic pregnancy patients, who received conservative treat- ment at Affiliated Ganzhou Hospital of Nanchang University and Ruijin Maternal & Child Health Care Hos- pital from January 2010 to December 2014. They were assigned to the observation group (153 cases) and the control group (97 cases) according to different treatment methods used. Patients in the control group were treated with Western medicine only (methotrexate + mifepristone). Those in the observation group were intramuscularly injected with methotrexate 50 mg/m² at day 1 . Then they took mifepristone 150 mg per day from day 2 to day 6, once per day for 5 successive days. Afterwards they took modified GR decoction from day 7, one dose per day. Clinical symptoms of all patients were observed. Blood levels of ß-hCG and progesterone were detected. Pelvic mass was examined in order to compare the curative effects between the two groups. Complications such as oral ulcer and gastrointestinal reactions were ob- served. Blood cells, hepatic and renal functions were monitored. The incidence of adverse reactions was compared between the two groups. Fallopian tube function was assessed by hysterosalpingography after healing. The fallopian tube patency rate was compared between the two groups. Results (1) The blood ß-hCG negative conversion time was (16. 70 ± 5. 88) days and the mass disappearance time was (4. 34 ±1. 15) weeks in the observation group, obviously shorter than those of the control group [ (22. 31 ±3. 35) days, (5. 80 ±0. 80 ) weeks , t = -7. 476, -9. 982; P <0. 01 ] in the control group. The cure rate was 98. 0% (150/153) in the observation group, and it was 73. 2% (71/97) in the control group, with statistical difference (x² =35. 730, P <0. 01). (2) The fallopian tube patency rate was 90. 7% (136/ 150) in the observation group and 78. 9% (56/97) in the control group, with statistical difference between the two groups (x² =5. 879, P <0. 05). (3) The incidence of adverse reactions: The incidence of gastro- intestinal reactions was 22. 0% (33/150) in the observation group and 22. 1% (15/71 ) in the control group. The incidence of mild gastrointestinal reactions was 9. 3% (14/150) in the observation group and 8. 5% (6/71) in the control group. The incidence of oral ulcer was 8. 0% (12/150) in the observation group and 7. 0% (5/71) in the control group. The incidence of leukopenia was 2. 0% (3/150) in the observation group and 2. 8% (2/71) in the control group. There was no statistical difference in these indices aforesaid between the two groups (x² =0. 022, 0. 046, 0. 062, 0. 145; P >0. 05). Conclusion Chinese herbs com- bined three-stage sequential therapy might be a safer and more effective treatment for ectopic pregnancy patients who had requirement for pregnancy.

Genetic variations in cytotoxic T-lymphocyte antigen-4 and susceptibility to cervical cancer.

Cytotoxic T-lymphocyte antigen-4 (CTLA-4), a molecule expressed predominantly on activated T cells, plays an important role in the down-regulation of T-cell activation. To evaluate the potential effects of CTLA-4 gene polymorphisms on susceptibility to cervical cancer, we genotyped polymorphisms in CTLA-4 (- 318 T/C, CT60 G/A,+49 G/A, - 658 T/C, and - 1661 G/A) and calculated odds ratios for the genotype and allele distributions between patients and controls. We then examined the functional relevance of the polymorphisms using enzyme-linked immunosorbent assays (ELISAs), in vitro lymphocyte proliferation assay, and cytotoxic assay. The CTLA-4 - 318 CC, CT60 AA, and+49 GG genotype frequencies were lower in patients than in controls (p <0.05). The frequencies of CTLA-4 - 318 T allele and CT60G allele carriers were significantly higher in patients than in controls (p <0.05). Upon stimulation, peripheral blood mononuclear cells (PBMCs) carrying the - 318TT and CT60GG genotypes exhibited significantly lower proliferation, IL-2, and IL-4 levels; fewer cytolytic activities; and higher TGF-ß levels compared with PBMCs carrying the - 318 CC/CT or CT60 AA/AG genotypes. We also found that CTLA-4 - 318 T/C and CT60 G/A single nucleotide polymorphisms were associated with the severity of cervical cancer. These results indicate that CTLA-4 - 318 T/C and CT60 G/A can affect cervical cancer susceptibility by altering the immune status of an individual.

Effects of estrogen on CD4(+) CD25(+) regulatory T cell in peripheral blood during pregnancy.

OBJECTIVE: To investigate the effects of estrogen (E2) level on regulatory T cells (Treg) in peripheral blood during pregnancy. METHODS: A total of 30 healthy non-pregnant women were selected as control group, 90 pregnant women of early, middle and late pregnancy and 30 postpartum women at 1 month after parturition were selected as experimental groups including early pregnancy group, middle pregnancy group and late pregnancy group; the proportions of CD4(+)CD25(+) Treg and CD4(+)CD25(+)CD127(-) Treg among CD4(+)T cells were detected by flow cytometry; the serum estrogen content in peripheral blood was detected by electrochemical immune luminescence method. RESULTS: E2 level was coincident with the change of Tregs number during pregnancy. The estrogen content in peripheral blood increased gradually from early pregnancy to late pregnancy, then decreased significantly after parturition, and the level at 1 month after parturition down to the level in non- pregnancy group (P>0.05); the level of E2 in pregnancy groups were significantly higher than those in non- pregnancy group (P<0.01); and there were significant differences among early pregnancy group, middle pregnancy group and late pregnancy group (P<0.05). The proportions of CD4(+) CD25(+) Treg and CD4(+) CD25(+) CD127(-) Treg in pregnancy groups were significantly higher than those in non- pregnancy group (P<0.05), but decreased significantly after parturition, and there was no significant difference between non- pregnancy group and postpartum women group (P>0.05); the proportions in middle and late pregnancy groups were significantly higher than those in early pregnancy group (P<0.05), but decreased slightly in late pregnancy group, there was no significant difference between late pregnancy group and middle pregnancy group (P>0.05). There was correlation between Tregs number with estrogen level during pregnancy. The proportion of CD4(+) CD25(+) Treg and CD4(+) CD25(+) CD127(-) Treg were positively correlated with estrogen level. CONCLUSIONS: High proportion of CD4(+) CD25(+) Treg and CD4(+)CD25(+)CD127(-) Treg is closely related to the high level of E2 during pregnancy. It suggested that high level of estrogen may induce an increase of CD4(+) CD25(+) Treg in peripheral blood, and then influence the immune function of pregnant women. The results of this experiment might play an important role of estrogen in immune-modulation during pregnancy.