목 적: 말초혈액 $CD56^+$ 자연살해세포 (natural killer cell)이 증가되어 있는 반복유산 환자들의 탈락막 $CD56^+/CD16^+$ 자연살해세포의 분포를 확인하고 말초혈액자연살해세포의 발현양상과 상관관계가 있는지 확인해 보고자 한다. 연구방법: 반복유산 환자 중 계류유산이 되어 자궁경부확장배출술과 배아 염색체검사를 시행하였던 환자 가운데 배아 염색체검사가 정상이고 말초혈액에서 자연살해세포 중 $CD56^+$ 자연살해세포가 증가된 환자들 29명을 대상으로 연구하였으며, 대조군으로는 배아 염색체검사가 비정상인 32명을 선택하였다. 이 환자들의 검체에서 착상부위를 포함한 자궁 탈락막세포를 확인하여 면역조직화학염색을 통해 $CD56^+$와 $CD16^+$ 자연살해세포의 분포를 확인하였다. 면역조직화학염색은 score와 백분율을 구하여 평가하였다. 결 과: 연구군과 대조군의 탈락막조직 $CD56^+$ 자연살해세포 score ($43.6{pm}24.5$ vs. $23.9{pm}16.3$ P =0.001)와 $CD56^+$ NK cell percentage ($42.1{pm}11.7$ vs. $33.9{pm}15.8$ P =0.027)는 유의한 차이가 있었다. 그러나 탈락막조직 $CD16^+$ NK cell score ($18.7{pm}9.5$ vs. $13.2{pm}39.4$ P =0.108)와 $CD16^+$ 자연살해세포 percentage ($24.7{pm}5.9$ vs. $23.4{pm}11.7$ P =0.599)는 통계학적으로 유의한 차이가 없었다. 말초혈액자연살해세포가 증가되어 있는 환자군에서 탈락막자연살해세포의 score와 말초혈액자연살해 세포의 백분율간에 직접적인 상관관계는 없었다 (peripheral $CD56^+$ NK cell percentage vs. decidual $CD56^+$ NK cell score, r=-0.016, P =0.932, peripheral $CD16^+$ NK cell percentage vs. decidual $CD16^+$ NK cell score, r=0.008, P =0.968). 결 론: 본 연구에서는 말초혈액 CD56^+ 자연살해세포가 증가되어 있는 반복유산 환자의 계류유산된 조직에서 탈락막 $CD56^+$ 자연살해세포가 증가되어 있다는 것을 보여 주었다. 또한 탈락막자연살해세포와 말초혈액자연살해세포의 증가 양상에서는 직접적인 상관관계는 없었다. 이는 탈락막자연살해세포가 반복유산의 면역학적인 기전에서 중요한 역할을 할 것이라는 가능성을 제시하여 준다.
Objective: The purpose of this study was to quantify decidual $CD56^+$ and $CD16^+$ NK cell subtype population and to evaluate the correlation between decidual NK cell expression and peripheral $CD56^+$ NK cell expression in women with a history of recurrent abortion and increased peripheral NK cells. Methods: Twenty-nine women with recurrent abortion and elevated peripheral $CD56^+$ NK cell percentage who had chromosomally normal conceptus were included in this study. Thirty-two women with recurrent abortion who had chromosomally abnormal conceptus were used as controls. Distribution of $CD56^+$ and $CD16^+$ NK cells in decidual tissues including implantation sites was examined by immunohistochemical staining. The degree of immunohistochemical staining was interpreted by score and percentage. Results: There was a significant difference in decidual $CD56^+$ NK cell score ($43.6{pm}24.5$ vs. $23.9{pm}16.3$ P =0.001) and $CD56^+$ NK cell percentage ($42.1{pm}11.7$ vs. $33.9{pm}15.8$ P =0.027) between increased peripheral NK cell group and control group. However, there was no statistically significant difference in decidual $CD16^+$ NK cell score ($18.7{pm}9.5$ vs. $13.2{pm}39.4$ P =0.108) and $CD16^+$ NK cell percentage ($24.7{pm}5.9$ vs. $23.4{pm}11.7$ P =0.599). There was no significant correlation between decidual NK cell score and peripheral NK cell percentage in increase peripheral NK cell group (peripheral $CD56^+$ NK cell percentage vs. decidual $CD56^+$ NK cell score, r=-0.016, P =0.932, peripheral $CD16^+$ NK cell percentage vs. decidual $CD16^+$ NK cell score, r=0.008, P =0.968). Conclusion: This study shows that $CD56^+$ decidual NK cells are increased in decidua of women exhibiting a history of recurrent abortion with increased $CD56^+$ peripheral NK cell. There was no significant correlation between decidual and peripheral NK cell increment in increase peripheral NK cell group. This study suggests the possibility that decidual NK cells may play an important role in the immune mechanism of recurrent abortion.
