自身抗体与不孕及自发性流产关系的探讨

目的检测抗心磷脂抗体(ACA)和抗精子抗体(AsAb)两种自身抗体在不孕及自发性流产患者中存在的情况,并观察应用阿司匹林治疗ACA阳性反复流产患者的临床效果。方法应用酶联免疫吸附(ELISA)法检测150例原发或继发不孕患者(不孕组)、198例自发性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ACA及AsAb抗体。对其中53例ACA阳性反复流产患者在孕前一个月或孕早期采用低剂量阿司匹林治疗。结果不孕组及流产组ACA总阳性率分别为48.00%和50.51%,与对照组(7.50%)相比有非常显著性差异(P<0.001);不孕组及流产组AsAb阳性率分别为31.33%和25.25%,与对照组(10.00%)比较亦有显著性差异(P<0.05)。53例经治疗患者活产婴儿48例,妊娠成功率为90.57%。结论ACA和AsAb等自身抗体是导致不孕及自发性流产的免疫学因素之一,应用低剂量阿司匹林治疗ACA阳性反复流产患者是保证其妊娠成功的有效方法。     

403例不孕不育患者血清抗精子抗体分析

目的探讨不孕不育与抗精子抗体（AsAb）的相关性。方法采用金标斑点渗滤法检测403例不孕不育患者血清中AsAb,并与对照组相比较。结果不孕不育组AsAb总阳性检出率为27.30%（110/403）,女性不孕患者阳性率为27.84%（93/334）,男性不育患者阳性率为24.64%（17/69）,不孕不育组与对照组比较,差异有统计学意义（P〈0.01）。结论 AsAb与不孕不育密切相关,检测血清AsAb有助于免疫性不孕不育的诊断。     

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     

反复自然流产患者血清ThAb、AsAb、EMAb和AoAb检测的临床意义

目的:探讨了反复自然流产患者血清ThAb、AsAb、EMAb和AoAb水平的变化及临床意义。方法:应用放射免疫分析和斑点免疫法对84例反复自然流产患者进行了血清ThAb、AsAb、EMAb和AoAb的检测,并与35名健康孕妇作比较。结果:反复自然流产患者血清ThAb、AsAb、EMAb和AoAb的阳性率显著地高于正常孕妇组(P<0.05)。结论:检测反复自然流产患者血清ThAb、AsAb、EMAb和AoAb水平的变化对疾病的诊断和发病机制有一定的临床价值。     

反复流产患者3种自身抗体的流行病学研究

目的研究本地区反复流产与AcAb、EmAb和AsAb的相关性。方法以720例主诉反复流产妇女为观察组,以672名同龄已育妇女为对照,ELISA法检测血清中的AcAb、EmAb和AsAb,组间比较采用χ2检验。结果观察组AcAb、EmAb和AsAb的阳性率分别为18.5%、21.7%和14.9%,显著高于对照组(P<0.05)。结论AcAb、EmAb和AsAb阳性是免疫性流产的重要原因,自身抗体检测是反复流产史患者病因学分析的重要方面。     

456例免疫性不孕患者血清AsAb、ACLA检测结果分析

目的 探讨抗精子抗体(AsAb)、抗心磷脂抗体(ACLA)在女性不孕中的意义.方法 采用ELISA方法检测456例不孕患者血清中AsAb、ACLA,同时选取已正常生育的妇女220例作为时照.结果 不孕患者AsAb阳性156例,阳性率为34.2%(156/456);ACLA阳性134例,阳性率为29.4%(134/456),对照组ACLA阳性8例,阳性率为3.6%(8/220),不孕组ACLA阳性率显著高于对照组(P<0.005).结论 AsAb、ACLA与不孕关系密切,血清中AsAb、ACLA的存在是不孕的危险因素.     

不孕不育患者免疫抗体分析

目的探讨四种免疫抗体（AsAb、EmAb、AcAb、AoAb）的产生导致不孕不育的机制及有效治疗方法。方法对我院优生优育门诊3509例不孕不育患者的血清用酶联免疫吸附法（ELISA）进行四种抗体的检测。结果检测原发不孕组309例,AsAb、EmAb、AcAb、AoAb阳性检出率分别为9.4%、19.6%、13.96%、12.82%。继发不孕组1009例,As-Ab、EmAb、AcAb、AoAb阳性检出率为30.11%、47.1%、17.0%、53.6%;孕早期胚胎发育停止不育组461例,AsAb、EmAb、AcAb、AoAb阳性检出率分别为8.7%、24.2%、17.6%、13.4%;反复流产不育患者1730例,AsAb、EmAb、AcAb、AoAb阳性检出率分别为8.7%、24.2%、17.6%、37.9%。结论ASAb、EMAb、AcAb、AOAb的存在与女性不孕有明显关系,免疫性不孕抗体的检测对临床不孕不育患者的诊疗以及预后的判断可以提供有价值的指标。     

育龄妇女不育不孕的实验室诊断及实验结果分析

目的探讨育龄妇女自身免疫抗体及生殖道衣原体(CT)、支原体(UU)感染与不育不孕患者的关系。方法选择2007年来我院门诊就诊和妇科住院的自然流产患者、不孕患者,没有反复流产史,且有一个健康婴儿的健康体检者,分别检测封闭抗体(APLA)、抗精子抗体(AsAb)、抗子宫内膜抗体(EMAb)、抗心磷脂抗体(ACA)解脲支原体(UU)和沙眼衣原体(CT)。结果自然流产患者中APLA阴性占75%,不孕患者APLA阴性占17.73%,对照组APLA阴性占8.14%;流产组、不孕组的APLA、AsAb、EMAb、ACA、UU、CT阳性检出率明显高于对照组。结论育龄妇女体内存在APLA、AsAb、ACA、EMAb及生殖道支原体或衣原体感染与不育不孕患者密切相关,对有不良孕产史及不孕的患者进行自身免疫抗体及生殖道衣原体、支原体的检测,可为诊断及治疗提供科学的依据。     

抗子宫内膜抗体和抗精子抗体与不孕症的相关性研究

目的探讨抗子宫内膜抗体和抗精子抗体与不孕症诊治的相关性。方法选取2018.01-2018.07来我中心就诊的不孕患者217例为试验组,选取同期健康体检妇女102例为对照组,分别检测EMAb和AsAb。结果 217例不孕患者中,EMAb阳性率为10.6%(23/217),对照组阳性率2.9%(3/102);AsAb阳性率为12.9%(28/217),对照组阳性率3.9%(4/102)。与对照组相比,P值均0.05,差异具有显著性。结论 EMAb和AsAb与不孕症密切相关,对不孕患者进行EMAb和AsAb的检测具有重要的临床意义。     

581例女性不孕患者血清免疫性抗体结果分析

目的探讨女性不孕与血清免疫性抗体的关系。方法对581例不孕妇女血清进行抗心磷脂抗体（AcLAb）,抗子宫内膜抗体（EMAb）,抗卵巢抗体（AoAb）,抗精子抗体（AsAb）检测,结果AcLAb阳性17例,阳性率2.93%,EMAb阳性85例,阳性率14.63%,AoAb34例,阳性率5.85%,AsAb阳性144例,阳性率24.78%。结论血清免疫性抗体是导致女性不孕的一个重要原因。     

抗生殖免疫抗体与不明原因反复自然流产的关系

目的：为探讨抗生殖免疫抗体与不明原因反复自然流产的关系。方法：采用ELISA法检测52例不明原因反复自然流产(流产组)血清抗精子抗体(AsAb)、抗子宫内膜抗体(EmAb)、抗卵巢抗体(AovAb)、抗心磷脂抗体(AcAb)和抗绒毛膜促性腺激素抗体(AhcGAb)的含量。结果：流产组AsAb阳性26．92％,EmAb阳性42．30％,AovAb阳性30．76％,AcA阳性46．15％和AhcGAb阳性48．07％;流产组的各项抗生殖免疫抗体检出率均明显高于对照组。结论：以上5种抗生殖免疫抗体可干扰卵的发育成熟、排卵、受精、胚泡着床和胚胎发育等过程。抗生殖免疫抗体与不明原因反复自然流产关系十分密切。     

Association between infertility and spontaneous abortion.

Women experiencing recurrent spontaneous abortion have a higher frequency of infertility than that expected in the general population. To further define the relationships between infertility and spontaneous abortion, the obstetrical histories of 43 women with unexplained secondary infertility were evaluated for the frequency of spontaneous abortion. Of the 88 pregnancies studied, 39 (44%) resulted in spontaneous abortion. Women with unexplained secondary infertility experienced a three-fold increase (P less than 0.0001) in the frequency of spontaneous abortions and half the number of live births (P less than 0.0001) compared with the general population. We conclude that the association between infertility and spontaneous abortion includes a higher frequency of spontaneous abortion among infertile couples as well as a higher prevalence of infertility among recurrent spontaneous aborters compared with the general population.     

抗子宫内膜抗体和抗精子抗体在临床中的价值探讨

目的探讨抗精子抗体和抗子宫内膜抗体在临床上检测原发性不孕和复发性自然流产的价值。方法回顾性分析2018年1月至2018年12月在复旦大学附属妇产科医院诊治的原发性不孕患者及复发性自然流产患者病史,以同期进行常规检查的孕妇作为对照,对比研究对象抗子宫内膜抗体、抗精子抗体的水平,分析抗子宫内膜抗体、抗精子抗体在原发性不孕和复发性自然流产中可能的相关性。结果收集到原发性不孕患者170例及复发性自然流产患者238例病史资料,以同期进行常规检查的孕妇208例作为对照组。原发性不孕患者抗精子抗体检测阳性例数显著高于对照组,但抗子宫内膜抗体并无显著改变;复发性自然流产患者抗子宫内膜抗体检测阳性率显著高于对照组,但抗精子抗体并无明显不同;早孕期流产患者抗精子抗体检测阳性率显著高于对照组;发生复发性自然流产在4次以上的病人,其体内抗子宫内膜抗体和抗精子抗体的水平均显著高于对照组。结论抗子宫内膜抗体和抗精子抗体检测在复发性自然流产和原发性不孕患者中具有相关的临床价值,应加强备孕人群的筛查工作,及早干预。     

PCR检测沙眼衣原体与习惯性流产和女性不孕相关性研究

本文应用聚合酶链反应技术（ＰＣＲ），对１２０例不孕和１００例查体妇女的宫颈内膜标本进行沙眼衣原体检测，以了解女性沙眼衣原体感染与自发流产的关系，并与一般细胞培养法进行了比较。结果：不孕妇女中沙眼衣原体感染率为１８．３％，显著高于对照组（８％Ｐ＜０．０５），并且自发流产３次、４次的妇女沙眼衣原体阳性率明显高于对照组（Ｐ＜０．０１）．敏感性也较一般培养法高（Ｐ＜０．０１）。本研究提示：沙眼衣原体感染与自发性习惯性流产关系十分密切，而且ＰＣＲ法在检测沙眼衣原体感染方面较一般培养法更敏感、快速，是早期诊断生殖道沙眼衣原体感染的一项有价值的方法。     

Human chorionic gonadotrophin-beta gene sequences in women with disorders of HCG production

Women with recurrent abortion, primary unexplained infertility, and gestational trophoblastic neoplasia (GTN) manifest disordered human chorionic gonadotrophin (HCG) secretion. Mutations in the HCG beta/luteinizing hormone (LH) beta gene complex could cause aberrant HCG production in these disorders. The purpose of this study was to determine whether HCG beta gene deletions occur in women with recurrent abortion or primary unexplained infertility, and whether HCG beta gene duplications are present in women with GTN. DNA was extracted from 10 patients with unexplained recurrent abortion, 10 patients with unexplained primary infertility, 12 patients with GTN, three partners of women with GTN, and 30 controls. Southern blots were constructed and hybridized with DNA probes for HCG beta-5 and the LH beta gene. No gene deletions were identified in patients with recurrent abortion or primary unexplained infertility. Likewise, no gene duplications were identified in women with GTN. A previously described Mbol restriction fragment length polymorphism (RFLP) was identified in both patients and controls. A new Pstl RFLP was also characterized, but was present in patients and controls. Deletion/duplication mutations in the HCG beta/LH beta gene complex do not appear to be common causes of aberrant HCG production in humans with these disorders.      

Heterochromatic chromosome variation and reproductive failure

The literature on the association of heterochromatic chromosome variants and reproductive failure, manifesting as infertility or recurrent spontaneous abortion, is critically reviewed. Many methodological problems confound attempts to interpret the data. The weight of evidence is against autosomal variants having any significant effect. Although conflicting, reports on the effect of Y heterochromatin variants on both infertility (Yq-) and recurrent abortion (Yq+) are mainly positive, and further data are required in both these areas.     

Ultrasonographic detection of a live fetus in recurrent spontaneous abortion during the first trimester

To examine whether recurrent spontaneous abortion (RSA) canbe distinguished from repeated sporadic spontaneous abortion,the clinical course of 38 cases with three or more consecutiveand unexplained first trimester RSAs were retrospectively investigatedin this study. For comparison with controls, the clinical coursewas examined of 38 fertile females, who had had sporadic abortions.In 19 (50%) RSAs and 6 (16%) controls, fetal cardiac activitywas demonstrated by ultrasound during the course of pregnancy.The rate of detection of live fetus during pregnancy or at 8weeks ± 7 days gestation, was significantly greater inthe RSA group compared to the control. The rate of vaginal bleedingbefore spontaneous abortion was significantly less in the RSAgroup than in the control group. There was no difference betweenthe two groups in age or gestational age at spontaneous abortion.The patients with RSA were all examined for antiphospholipidantibodies in their sera and these were detected in eight ofthem. However, there was no difference in the rate of positivefetal cardiac activity between the RSA patients who tested positiveor negative for antibody. These results reveal that the clinicalcourse of RSA is very different from the course of sporadicabortion. Although sporadic abortion is a common complicationof pregnancy, RSA is not a random repeated abortion, but rathera separate disease from sporadic abortion in normal fertilefemales.     

Distributions of endometrial NK cells,B cells,T cells,and Th2/Tc2 cells fail to predict pregnancy outcome following recurrent abortion

PROBLEM: To evaluate the ability of immunophenotypes of endometrial leukocytes from patients with histories of recurrent abortion to predict outcome of subsequent pregnancy. METHODS OF STUDY: Seventeen women with two successive spontaneous abortions with normal karyotype in the conceptus and 15 women with male-factor infertility were studied. Subsequent pregnancy outcomes in 17 recurrent abortion patients were noted; 11 had live birth, while six aborted in the first trimester. All of 15 women with male-factor infertility became pregnant after therapy, resulting in live birth in all cases. Endometrium was sampled during the peri-implantation period before subsequent pregnancy. We immunostained paraffin-embedded sections for lymphocyte markers including natural killer (NK) cell markers, CD56 and CD16, a B-cell marker CD20, T-cell markers CD3 and CD8, and a specific T-helper(Th)2 and T-cytotoxic (Tc)2 marker termed 'chemoattractant receptor-homologous molecule expressed on Th2 cells' (CRTH2). Immunoreactive cells for these antigens were counted and positivity ratios to CD45- or CD3-positive cells were calculated. These parameter were compared between 17 patients with histories of recurrent abortion and 15 control women and also compared between 11 patients whose subsequent pregnancy was successful and six patients whose subsequent pregnancy was a failure. RESULTS: Numbers of CD45+, CD56+, CD16+, CD20+, CD3+, CD8+, and CRTH2+ cells in recurrent abortion patients resembled those in controls. No significant difference in lymphocyte subset numbers or ratios was noted between patients whose subsequent pregnancy was successful and those who again aborted. CONCLUSION: We could not predict pregnancy outcome by immunophenotypic analysis of endometrium in women with recurrent abortion.