279例复发性流产封闭抗体检测及淋巴细胞主动免疫治疗疗效观察

目的 观察原因不明复发性流产（RSA）患者经丈夫或无关个体淋巴细胞免疫治疗后其体内封闭抗体（BA）的变化及妊娠成功率.方法 279例封闭抗体阴性的患者分为实验组和对照组,实验组237例给予丈夫或无关个体的外周血淋巴细胞免疫治疗及常规保胎治疗,对照组42例只进行常规保胎治疗,比较两组治疗前后BA的变化及再次妊娠的结局.结果 BA阴性者237例,经过2个疗程的主动免疫治疗后BA转为阳性者152例.3个月内B超监测到排卵后妊娠126例,其中中晚期妊娠或分娩共109例,17例妊娠12周内再次发生流产,治疗成功率为71.71％ （109/152）.经过2个疗程免疫治疗后仍为阴性者85例,妊娠39例,妊娠大于20周或分娩共21例,治疗成功率为24.71％ （21/85）.上述两组数据经统计学分析,有显著性差异（x2值=48.64,P＜0.05）;对照组42例,妊娠17例,妊娠维持20周以上7例,流产10例.妊娠成功率为16.67％ （7/42）.实验组妊娠成功率为54.85％,与对照组比较有显著性差异（x2值=20.82,P＜0.05）.结论 淋巴细胞主动免疫治疗可提高BA阴性的不明原因复发性流产患者BA的阳性率,提高母体免疫耐受,提高再次妊娠成功率.

Study of Detection of Blocking Antibody and Immunotherapy With Lymphocytes in Women With Recurrent Spontaneous Abortion

Objective To investigate the changes of blocking antibody and success rates of Pregnancy after immunotherapy with lymphocytes in women with recurrent spontaneous abortion. Methods 279 patients diagnosed as RSA caused by lacking blocking antibodies were divided into two groups： 237cases as group of immunotherapy （ control group）, another 42 cases with no immunotherapy （ comparison group）. Compared the changes of BA and the success rates of pregnancy after active immunotherapy between the two groups of patients. Results There were 152 patients with BA turned into positive after 2 courses of active immunotherapy in 237 cases of BA- negative patients. There were 126 cases of pregnancy by B - mode ultrasound detected in 3 months, 109 cases had entered in the late stage of pregnancy or childbirth in 129 patients. 17 cases suffered re - abortion within 12 weeks of pregnancy. The success rates of pregnancy were71.71% （109/152）. 85 cases of BA were still negative after 2 courses of immunotherapy. There had entered in the late stage of pregnancy or childbirth were 39 cases of pregnancy in 85 patients. 21 cases in 85 patients. The success rates of pregnancy were24,71% （21/85）. There was a significant difference for the rate of pregnancy between these two groups（x^2 = 48,64, P 〈 0.05）. In comparison group, There were 17 cases of pregnancy in 42 patients. 7 cases had entered in more than 20 weeks of pregnancy in comparison group. 10 case suffered abortion. The success rates of pregnancy were 16.67 % （7/42）. In control group and comparison group, there was a significant difference for the rate of pregnancy between these two groups（x^2 = 20.82, P〈 0.05）. Conclusion Immunotherapy with lympho- cytes in women with RSA caused by lacking blocking antibodies may increase pregnancy rate and had credible curative effect and application value.