反复自然流产患者血浆前列环素和血栓素水平及其与抗心磷脂抗…

用ＲＩＡ法检测了４６例不明原因的反复自然流产（ＲＳＡ）患者血浆６－ｋｅｔｏ－ＰＧＦ１ａ和ＴＸＢ２水平，并对其与抗心磷脂抗体（ＡＣＡ）的关系进行了研究。结果表明，ＲＳＡ患者有一定程度的血栓素升高和前列环素的降低，其中尤以ＡＣＡ阳性者更为明显，Ｔ／Ｋ比值较对照组显著增高（Ｐ〈０．０１）。体外实验尚未发现ＡＣＡ对血小板释放ＴＸＡ２有明显的促进作用，对其原因也进行了分析。本文还就ＡＣＡ阳性患者血浆ＴＸＢ２     

反复自然流产及不孕症患者中抗心磷脂抗体的检测

抗心磷脂抗体 (ａｎｔｉｃａｒｄｉｏｌｉｐｉｎａｎｔｉｂｏｄｙ ,ＡＣＡ)系一种酸性磷脂的异质性自身抗体 ,靶抗原为带负电的磷脂成分 ,并参与多种细胞膜的组成 ,为了解反复自然流产 (ＲＳＡ)及女性不孕症患者中ＡＣＡ的阳性率及其临床意义 ,我们应用ＥＬＩＳＡ法对 2 0 3例女性不孕症患者 ,49例ＲＳＡ患者及 30例体检健康女性进行了ＡＣＡ检测 ,并对其阳性患者进行了ＩｇＧ、ＩｇＡ及ＩｇＭ分型。现将结果报告如下。资料与方法一、受检标本 :女性不孕症患者血清标本 2 0 3例 (均为结婚 2年以上未孕者 ) ,年龄 2 5 - 35岁 ;ＲＳＡ患者 49…     

不孕及反复流产患者血清抗心磷脂抗体的检测

目的检测不孕及反复流产患者血清中的抗心磷脂抗体(ACA),探讨ACA的临床意义.方法应用酶联免疫吸附(ELISA)法检测105例原发或继发不孕患者(不孕组)、171例反复流产或有胚胎停育史患者(流产组)及40例正常对照组血清中的IgG、IgM及IgA-ACA 3种抗体.结果不孕组ACA总阳性率为44.76%,流产组为35.09%,均显著高于对照组(P＜0,01).不孕组及流产组的单纯IgG阳性率亦明显高于对照组(P＜0.05);而两组的单纯IgM阳性率与对照组相比,差异均无显著性意义(P＞0.05).结论ACA是导致不孕及反复流产的免疫学因素之一,IgG型的ACA比IgM型的更具临床意义     

反复流产与抗心磷脂抗体关系的探讨

目的探讨反复流产、宫内死胎,孕中、晚期孕妇与抗磷脂自身抗体的关系.方法采用ELISA方法对1934例患者进行ACA-IgG、ACA-IgM抗体测定.结果表明有反复流产、宫内死胎史患者血中ACA阳性检出率为30.29%.正常早中晚妊娠妇女阳性率为5.11%,检出阳性者中多为先兆流产、宫内发育迟缓及轻度妊高征.结论ACA阳性与反复流产、宫内死胎、先兆流产、宫内发育迟缓有密切关系.     

心磷脂抗原的纯化与三类特异抗心磷脂抗体测定方法的建立

用甲醇：氯仿抽提，硅胶柱，薄层层析法分离纯化自新鲜牛心中提取心磷脂，经硅胶板层和高效液相色谱分析，其比移值与峰形与心磷脂标准品完全一致。用此心磷脂包被反应板建立了检测抗心磷脂抗体的间接ＥＬＩＳＡ法。     

反复自然流产的免疫因素分析探讨

为分析探讨反复自然流产的免疫性因素，应用补体微量淋巴细胞毒实验方法检测女性反复自然流产的封闭抗体，用ELISA法检测女性反复自然流产的抗心磷脂抗体(ACA)、抗精子抗体(ASA)共752例。结果显示，封闭抗体与反复自然流产明显相关，抗心磷脂抗体与反复自然流产有一定关系，抗精子抗体与反复自然流产无明显相关。研究表明，封闭抗体、抗心磷脂抗体是造成反复自然流产的重要免疫因素。     

习惯性流产者抗心磷脂抗体检测及其意义

65例习惯性流产患者分为甲组(有妇产科原因)和乙组(不明原因)。检测结果表明,全部患者ACL的阳性率为18.5％,明显高于抗DNA、抗ENA抗体的检出率(P<0.01),乙组ACL的阳性率高于甲组,提示ACL在原发性习惯性流产的发病机理中起着一定的作用。ACL阳性的患者对HCG的治疗反应比阴性组差(p<0.01),提示ACL阳性的习惯性流产者应采用其他的治疗方法如糖皮质激素加小剂量阿斯匹林等。     

不明原因的反复自发性流产与抗心磷脂抗体关系的探讨

<正>近来有报道,抗心磷脂抗体（ACA）与临床表现为血管栓塞,血小板降低及反复自发性流产（RSA）的抗磷脂抗体综合征密切相关。本文收集一批不明原因的RSA患者血清,检测其ACA水平,现报告如下。     

44例流产患者抗心磷脂抗体检测结果分析

目的：为拓展流产病因的监测手段,探讨抗心磷脂抗体（anticardiolipin antibody ACA)与流产的关系,方法：采用酶联免疫吸附试验（ELISA）,其细节为：将心磷脂抗原包被于反应板微孔内,加入待测血清,随后加入酶标记抗人IgG,IgM抗体,在酶底物作用下显色,显色强度与ACA水平一致。对44例流产患者进行ACA测定,结果：44例流产患者中,ACA阳性率高达43．2％,正常对照组33例,阳性率21．2％,二组间经x检验,P＜0．05,有显著差异,结论：尽管流产的因素很多,有遗传,内分泌,感染和免疫等。但本组资料表明：ACA与流产关系密切,应予以重视,可作为常规筛查项目之一,以指导临床治疗。     

自发性流产患者抗心磷脂抗体检测结果分析

用ELISA法作 2 6 4例自发性流产患者血清抗心磷脂抗体包括ACA -IgM及ACA -IgG检测 ,其结果提示 :3次以上流产 (习惯性流产 )与ACA -IgM的关系较对照组有显著性差异 ,而 1～ 2次流产患者与对照组比较无显著性差异 ,且各组均与ACA -IgG无相关性。     

Diagnostic and Prognostic Significance of Anticardiolipin Antibodies in Patients With Recurrent Spontaneous Abortions

PROBLEM : The role of ACA in unexplained RSA is controversial. In the present study, diagnostic and prognostic aspects were investigated. METHOD : One hundred five nonpregnant patients with primary, 29 with secondary RSA, and 209 controls were investigated for IgG-ACA. Follow-up studies were done during pregnancy in 76 individuals. IgM-ACA were tested in a subset of patients. RESULTS : Elevated ACA levels were significantly more frequent in both patient groups (26 and 24%) than in controls (16%). However, there was no correlation of ACA with various parameters including pregnancy outcome. In ACA-positive patients with successful pregnancy a significant decrease of ACA values during pregnancy was observed, while ACA remained high in aborting patients. IgG- and IgM-ACA correlated well. CONCLUSIONS : Although the data from nonpregnant RSA patients does not allow diagnostic or prognostic conclusions to be drawn, sequential testing of ACA-positive individuals provides the possibility to foresee pregnancy outcome.     

肝硬化患者血浆PGI2和TXA2含量变化的临床意义

目的:观察肝硬化患者血浆中前列环素（PGI₂）和血栓素A₂（TXA₂）含量的变化,探讨其在肝病发生、发展中的临床意义。方法:选取2010年10月～2011年10月间云南省第三人民医院消化内科收治的肝硬化患者48例及健康体检正常者30例,采用放射免疫分析（RIA）分别测定其血浆中PGI₂和TXA₂的代谢产物6-酮-前列环素(6-Keto-PGF_1α)和血栓素B₂（TXB₂）的含量,进行统计学分析。结果:Child-Pugh分级A级患者血浆中6-Keto-PGF_1α和TXB₂含量分别为（108.8±34.2）ng/L和（87.5±19.3）ng/L,B级为（139.4±38.3）ng/L和（106.6±20.7）ng/L,C级为（181.9±53.2）ng/L和（128.5±26.3）ng/L,正常对照组为（90.6±23.6）ng/L和（73.6±18.3）ng/L,经方差分析,各组之间差异有统计学意义（F值分别为5.12,4.63,P均<0.01）;各组间经SNK-q检验比较,差异均有统计学意义（P均<0.01）;血浆中6-Keto-PGF_1α和TXB₂含量在Child-Pugh分级A、B、C级患者中逐级增高。结论:血浆PGI₂和TXA₂参与了肝硬化的发生、发展,动态监测PGI₂和TXA₂含量的变化有利于肝硬化患者病情的判断。     

反复早期自然流产妇女血浆蛋白Z检测的意义

目的探讨反复早期自然流产妇女血浆蛋白Z（PZ）检测的意义。方法分别测定26例反复早期自然流产患者和30例相同孕周的正常妊娠妇女血浆PZ和纤维蛋白原（Fg）水平以及凝血酶原时间（PT）和活化的部分凝血活酶时间（APTT）,采用单因素方差分析和非参数检验比较两组之间各项指标水平的差异。结果反复早期自然流产组PT、APTT、Fg水平与正常妊娠组相比差异无统计学意义（P〉0.05）,但反复早期自然流产组血浆PZ平均水平显著低于正常妊娠组[（1.55±0.63）mg/Lvs（1.90±0.60）mg/L,F=4.57,P=0.037],且其血浆PZ中位水平（1.45mg/L,范围：0.62～3.25mg/L）也显著性低于正常妊娠组（1.74mg/L,范围：0.78～3.36mg/L）（χ^=25.485,P=0.019）;以PZ〈0.90mg/L作为PZ缺乏的标准,反复早期自然流产组有4例（15.4%）、正常妊娠组有1例（3.3%）血浆PZ缺乏,但二者差异无统计学意义（χ^=22.49,P=0.115）。结论反复早期自然流产患者常规凝血指标和PZ缺乏率与正常对照组无差异,但其血浆中抑制因子Ⅹa活性的PZ水平较低,表明其发病可能与低PZ水平有一定的关系。     

Intravenous Immunoglobulin in the Prevention of Recurrent Spontaneous Abortion: The European Experience

PROBLEM: Clinical trials of the use of intravenous immunoglobulin (IvIg) in the treatment of recurrent spontaneous abortion (RSA) in Europe were reported and discussed. METHOD OF STUDY: A search of the published literature, combined with our own published and unpublished results, was performed. RESULTS: Two placebo-controlled trials have been concluded in Europe. One trial found high but equal success rates in both the IvIg and the placebo group. Another trial found that IvIg treatment may increase the success rate by 24% compared with placebo but that the result was not statistically significant, which might be due to the small number of patients. Reasons for the diverse results of the two trials were discussed. CONCLUSION: More and larger placebo-controlled trials of IvIg treatment in RSA are needed before drawing definitive conclusions.     

复发性流产病因学研究现状分析

复发性流产为临床较为常见的妊娠并发症之一,属于妊娠早期衰退孕囊死亡的一种普遍形式,具有较高发生率,其不仅易影响女性心理健康与生活质量,还将对其妊娠结局产生直接影响,严重者可导致不孕不育,影响家庭和谐。随着生殖遗传学、生殖免疫学、分子细胞学技术的发展,临床对该疾病的发病机制有了新的发现,故本文将分析复发性流产的病因以及发病机制,拟为临床诊治提供理论依据,以改善妊娠结局,提高保胎成功率,降低RSA发生率。     

Worldwide Collaborative Observational Study and Meta-Analysis on Allogenic Leukocyte Immunotherapy for Recurrent Spontaneous Abortion1

PROBLEM: Recurrent spontaneous abortion (RSA) is a common complication of pregnancy for which there is no known cure. Therefore, effective treatment is needed. Published results from controlled clinical trials of allogeneic leukocyte immunization of women suffering from RSA have given conflicting results. To address this controversy, the international raw data of all patients who had been entered into clinical trials that included a control group were collected and analyzed. The primary question to be answered was whether alloimmune stimulation of the female partner improves the subsequent live birth rate. METHODS: Fifteen clinical centers were identified worldwide because they controlled appropriate raw data. Consequently, nine randomized trials (seven double-blinded) were evaluated independently by two separate data analysis teams to assure conclusions were robust. One team also compared randomized trials to the results of six nonrandomized cohort-controlled studies to test for bias in nonrandomized trials. Factors predicting successful live births among couples with RSA were evaluated by logistic regression. RESULTS: Although the two independent analyses made use of different definitions and utilized different statistical methods, the results of both were similar. The live birth ratios (ratio of live births in treatment and control groups) with 95% confidence intervals (CI) were 1.16 (CI, 1.01-1.34, P = 0.031) and 1.21 (CI, 1.04-1.37, P = 0.024), respectively. The absolute differences in live birth rates between treatment and control groups were 8% and 10% in respective analyses. Results in randomized and nonrandomized trials were surprisingly similar despite significant differences in composition of control and treatment groups. Live birth rates were lower with older female partners, more than five abortions, with a positive ANA or with positive anticardiolipin antibodies. Live birth rates were higher if the female partner had prior to treatment serum antibodies to paternal leukocytes or converted from negative to positive with immunization. Approximately 0.5% of controls and 2.1% of treated patients experience side effects for a 1.6% treatment related effect. There was no evidence of an increased risk of adverse effects on the fetus. CONCLUSIONS: Two independent analyses of worldwide data on allogeneic leukocyte immunization for treatment of RSA suggest that alloimmunization may be an effective treatment. The treatment effect appears, however, to be small, and the data indicate that immunotherapy helps only 8% to 10% of affected couples. A current lack of diagnostic tests defining patients who most likely would benefit from immunotherapy, precludes the identification of a patient population that would benefit most from such treatment. The efficacy of treatment in such a subgroup could be expected to increase and could be of sufficient magnitude to allow the determination of more effective immunization protocols. This study does not exclude the possibility of a partial correction of a widely prevalent immunology defect by immunotherapy. The presence of such a defect would indicate a need for more effective therapy. The unexplained variation in pregnancy success rates of control groups among centers continues to present a statistical problem, limiting the statistical evaluation of retroactively obtained data.     

改良单向混合淋巴细胞培养在反复自然流产诊疗中应用

为了避免现行封闭抗体检测方法的不合理性,对其进行改进,将男方刺激细胞与妇女待测血清孵育,然后分离结合了封闭抗体的刺激细胞,将经或未经封闭抗体作用的男方刺激细胞分别与女方反应细胞在25%正常AB型血清同等培养条件下培养6d.改进后方法测得正常生育组与原发性反复自然流产组封闭效率阳性率为57.1%及12.3%,均数为7.53±10.30及—55.51±13.41.改进后方法的准确度(81.7%)、灵敏度(87.8%)及特异性(57.1%)均高于改进前.在分析白细胞免疫疗法免疫效果时发现,改进后的方法更能准确反应患者体内封闭效率逐渐上升趋势.改进后的封闭效率在评价反复自然流产治疗的临床疗效时优于改进前.     

The Investigation on the Value of Repeat and Combination Test of ACA and Anti‐β2‐GPI Antibody in Women with Recurrent Spontaneous Abortion

Problem In order to investigate the value of anticardiolipin antibodies (ACA) and anti‐β₂‐GPI antibodies detection in screening autoimmune type recurrent spontaneous abortion and its clinic application in antiphospholipid syndrome diagnosis, we adopt repeat combined ACA and anti‐β₂‐GPI antibodies detection in this study. Method of study Sera were collected from patients and work‐up was done for detection of ACA and anti‐β₂‐GPI antibodies by enzyme‐linked immunosorbent assay (ELISA). The work‐up was done for detection of antibodies once in every 6 weeks for 14 times consecutively. Results The repeated and combined detection of ACA and anti‐β₂‐GPI antibodies detection could raise the positivity rate up to 21.8% (P < 0.05) in comparison with positive for ACA alone (14.1%), positive for anti‐β₂‐GPI alone (3.1%), and concurrently positive for both ACA and anti‐β₂‐GPI antibodies (4.6%). In 91 confirmed positive antiphospholipid antibodies (APA) patients, with more frequent screening for ACA and anti‐β₂‐GPI antibodies, more patients with APA were found. The positive rate of five and more screenings was over 81.32%, which was statistically significant (P < 0.05), in comparison with that of four or less screenings (68.13%). Conclusion Our data implied that it would be appropriate to take over five or more screenings of combined ACA and anti‐β₂‐GPI antibodies detection in suspect patients to facilitate the positive diagnostic rate for autoimmune type RSA.     

Influence of Histocompatibility Antigens in Recurrent Spontaneous Abortion Couples and on Their Reproductive Performances

PROBLEM: To determine if human leukocyte antigens (HLA) play any role in the aetiology of recurrent spontaneous abortion (RSA), a substantial group of RSA couples were studied, and their reproductive performances in a 3-year follow-up recorded. METHODS: HLA typing was performed for HLA-A, -B, and DR antigens in both partners of 75 couples with unexplained RSA, and compared with a control group of 30 fertile couples that never experienced abortion. A further 57 couples of this group were studied for their reproductive performance in a 3-year follow-up, and subdivided into three subgroups: 1) couples that achieved successful pregnancy during the follow-up; 2) couples that experienced abortion and no livebirth during the follow-up; and 3) couples that experienced infertility during the follow-up. RESULTS: There were no significant differences for antigen frequency in all the different HLA loci, and HLA antigen sharing between all the RSA couples and controls. Significant increase of sharing for HLA-DR locus was observed in the couples that aborted during the follow-up with respect to the couples that achieved livebirth and controls (P < 0.03 and P < 0.02 respectively), and significantly increased frequency of B44, DR5 antigen combination in the same comparison (P < 0.03). No significant differences were observed in terms of the interval between conceptions in couples without antigen sharing with respect to couples with 1, 2 or more antigens shared, and antigen sharing in Locus A, B or DR. CONCLUSIONS: The results suggest that gene(s) disadvantageous for reproduction may exist between the HLA-B and -DR chromosomal region which influences the pregnancy outcome in RSA couples, and that HLA-antigen sharing itself does not influence the outcome.