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Koo, Yi, Lee, Ahn, Choi, Sung, Hwang, Song, Koong, Kang, and Yang: Resistance of uterine radial artery blood flow is positively correlated with peripheral blood NK cell fraction in patients with unexplained recurrent spontaneous abortion
Original Article
Korean Journal of Obstetrics & Gynecology

Korean Journal of Obstetrics & Gynecology 2012; 55(7): 485-492.

Published online: 13 July 2012

DOI: https://doi.org/10.5468/KJOG.2012.55.7.485

Resistance of uterine radial artery blood flow is positively correlated with peripheral blood NK cell fraction in patients with unexplained recurrent spontaneous abortion

Hwa Seon Koo, MD, Hyun Jeong Yi, MD, Min Young Lee, MD, Hyun Suk Ahn, MD, Min Hye Choi, MD, Na Young Sung, MD, Yu Im Hwang, MD, In Ok Song, MD, Mi Kyoung Koong, MD, Inn Soo Kang, MD, Kwang-Moon Yang, MD

Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea.

Corresponding author: Kwang-Moon Yang, MD, PhD. Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, 17 Seoae-ro 1-gil, Jung-gu, Seoul 100-380, Korea. Tel: +82-2-2000-7545, Fax: +82-2-2000-7790, km1yang@naver.com

Received 6 March 2012       Revised 8 May 2012       Accepted 21 May 2012

Copyright © 2012. Korean Society of Obstetrics and Gynecology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To evaluate whether increased peripheral blood inflammatory immune cell can induce decrease of uterine blood flow in patients with unexplained recurrent spontaneous abortion (RSA).

Methods

This study designed prospectively 33 pregnant women between 5 to 7 gestational weeks with a history of unexplained RSA included in this study. 47 normal pregnant women between 5 to 7 gestational weeks without history of infertility and/or RSA included as a control. Peripheral blood natural killer (pbNK) (CD3-/56+) fractions among peripheral blood monocyte (PBMC) were checked by flow cytometry. Uterine color-pulsed Doppler trans-vaginal ultrasound for evaluation of uterine radial artery RI was checked. Uterine radial artery resistance index (RI) compared between study and control group. After then, uterine radial artery RI was compared between high pbNK cell fraction above 12.1% among PBMC and normal pbNK cells fraction below 12.1%. Correlation between pbNK cell fraction to uterine radial artery RI was also evaluated.

Results

Uterine radial artery RI in early pregnancy was significantly higher in patients with RSA than that of normal control (0.60 ± 0.14 vs. 0.54 ± 0.12, P=0.039). Especially, the mean value of uterine radial artery RI in RSA patients with elevated pbNK cells was significantly increased than that of normal control (0.62 ± 0.13 vs. 0.54 ± 0.12, P=0.029). Otherwise, pbNK cell fractions among PBMC displayed strong positive correlation to uterine radial artery RI (Pearson's correlation coefficient P=0.001, r = 0.667).

Conclusion

Increased pbNK cells can evoke decreased uterine blood flow by their pro-inflammatory action on micro vascular structure such as uterine radial artery. This can be a one causative mechanism of inducing spontaneous abortion by increased NK cells. But, larger scaled study is needed for clarify our results.

Keywords: Recurrent spontaneous abortion, Natural killer cell, Uterine radial artery resistance index

Figures and Tables

Fig. 1
Diagram of study subjects. pbNK, peripheral blood natural killer.
kjog-55-485-g001
Fig. 2
Analysis of peripheral blood natural killer (pbNK) cell fraction and NK cell cytolytic activities (NKA) by using flow cytometry at gestational age 5 to 7 weeks (A) analysis of pbNK by using flowcytometry. Circled area in left figure indicated lymphocyte population among peripheral blood monocyte (PBMC). Circled area in right figure indicated NK cell (CD3-56+) cell population among lymphocte. (B) Analysis of NKA by using flow cytometry. NKA was checked by % dead target cell (K562 cell) after 2 hour incubation of PBMC in three different effector to target (E:T) ratio.
kjog-55-485-g002
Fig. 3
Measurement of uterine blood flow by Doppler ultrasonogram. Resistance index (RI)=(peak systolic velocity-end diastolic velocity)/peak systolic velocity; Z1, zone for the 1st time measured resistance index; Z2, zone for the 2nd time measured resistance index; Z3, zone for the 3rd time measured resistance index.
kjog-55-485-g003
Fig. 4
Comparison of mean uterine radial artery resistance index. RI, resistance index; pbNK, peripheral blood natural killer.
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Fig. 5
Correration of uterine radial artery resistnace index and pbNK cell fraction in RSA group. RI, resistance index; RSA, recurrent spontaneous abortion.
kjog-55-485-g005
Fig. 6
Correlation between uterine RA-RI and pbNK cell fraction in normal and elevated NK groups. RA-RI, radial artery-resistance index; pbNK, peripheral blood natural killer.
kjog-55-485-g006
Table 1
Clinical characteristic of study groups
kjog-55-485-i001

Values are presented as mean ± standard deviation.

pbNK, peripheral blood natural killer cell; SA, spontaneous abortion; NKA, NK cell cytolytic acivity; NS, not significant.

aStatistically significant different between control and normal pbNK/control and elevated pbNK.

Table 2
Comparison of mean uterine radial artery resistance index between groups
kjog-55-485-i002

RSA, recurrent spontaneous abortion; normal pbNK, peripheral blood natural killer cell fraction among lymphocyte showed below 12.1%; elevated pbNK, peripheral blood NK cell fraction among lymphocyte showed above 12.1%.

aP=0.039, Student's t-test, bP=0.029, one-way analysis of variance.

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