自身免疫型习惯性流产的临床治疗

目的探讨三种不同方法治疗自身免疫型习惯性流产的临床效果。方法选取78例确诊为自身免疫异常引起的习惯性流产患者，分为4组，1为阿司匹林＋泼尼松组（22例），2为阿司匹林＋肝素组（18例），3为静丙组（20例），4为对照组（18例），不接受任何治疗，用卡方检验比较各组妊娠成功率。结果1、2、3组与对照组分别比较，差异均有统计学意义（P〈0．05），但3种治疗方法之间无显著差异（P〉0．05）；1组出现了胎膜早破、妊娠期高血压疾病等妊娠合并症，2组出现了早产和消化道出血，但各组发生率无统计学差异（P〉0．05）。结论传统的激素、抗凝剂和被动免疫疗法均有一定疗效，但三者之间疗效无差异。     

超声影像学与分子生物学在复发性自然流产的联合应用

目的探讨纤溶酶原激活剂抑制物-1(plasminogen activator inhibitor-1,PAI-1)基因4G/5G多态性和早期妊娠子宫动脉舒张期切迹与复发性自然流产的关系,为早期诊断和治疗复发性自然流产提供依据。方法应用聚合酶链反应-限制性片段多态性(PCR-RFLP)分析,对61例反复自然流产患者(病例组)和52例正常妊娠对照组(对照组)做了PAI-1基因4G/5G多态性分析,并应用彩色多普勒超声检测子宫动脉舒张期切迹(uterine artery diastolic notches depth,ND)结果1.复发性自然流产组有ND切迹者占54.1%(33/61),正常妊娠对照组为34.62%(18/52),二者差异有显著性意义(χ2=4.30,P<0.05,OR值为2.23,95%CI 1.04-4.77。2.携带4G/4G基因型患者其子宫动脉血流循环阻力有增加趋势,(χ2=16.08,P<0.01,OR值为6.0,95%CI 2.38-15.12。结论1.子宫动脉血流循环阻力增加与复发性自然流产的发病有关联。2.PAI-1基因4G/4G型个体,同时有ND者自然流产的风险为对照组的4.25倍...     

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     

Divergence of natural killer cell receptor and related molecule in the decidua from sporadic miscarriage with normal chromosome karyotype

The aim of this cohort study was to investigate immunophenotypic characteristics of natural killer (NK) cells by assessing specific molecules expressed in the decidua of sporadic miscarriages and induced abortions. The deciduae were obtained from 29 consecutively seen women whose pregnancies ended in first trimester miscarriages (MS), and the fetal chromosome karyotype of these MS was analysed. Additionally, 13 deciduae were obtained from induced abortion (IA) with informed consent. The expression of perforin, CD94, CD161, CD158a, CD158b, CD244 on CD3-CD56+NK cells, and perforin on CD3+CD8+ T cells was analysed by flow cytometry. The CD158a (mean+/-SD, 26.2+/-14.7%) and CD94 (50.2+/-25.7%) expressions in MS with normal chromosome karyotype (MSNK; n=11) were significantly decreased as compared with those (41.5+/-19.5%, 71.4+/-20.4%) in MS with abnormal karyotype (MSAK; n=18) and those (44.3+/-21.9%, 80.8+/-17.5%) in IA (n=13). Conversely, the perforin expression on CD3-CD8-CD56+NK cells (76.3+/-11.0%) and CD3+CD8+T cells (30.6+/-9.2%) in MSNK was significantly increased as compared with those (66.8+/-16.6%, 23.6+/-8.7%) in MSAK and those (62.9+/-11.6%, 19.7+/-8.1%) in IA. A positive correlation between CD94 and CD158a expressions on NK cells, negative correlations between CD94 on NK cells and perforin on NK cells/T cells, and between CD158a on NK cells and perforin on T cells were found in the decidua. A divergence of NK cell repertoire in the decidua might be related to aetiology of sporadic MSNK.     

An Animal Model for the Study of the Function of Pregnancy-Specific Beta1 Glycoprotein and Pregnancy Zone Protein: A Review*

ABSTRACT: Two pregnancy-associated murine proteins, PAMP-1 and PAMP-2, have been found to be immunologically cross-reacting analogues to the human proteins pregnancy zone protein (PZP) and pregnancy-specific beta₁-glycoprotien (SP-1), respectively. In this study, the physiochemical and biological properties of the proteins are compared and the effect on pregnancy of administration of monospecific antibodies against the proteins is reported.     

An effective regimen for early medical abortion: a report of 2000 consecutive cases

A combination of the anti-progesterone mifepristone and gemeprostprovides an effective non-surgical method for the inductionof abortion at gestations up to 63 days, achieving completeabortion rates of over 95%. We report our experience with analternate regimen, comprising a reduced dose of mifepristonein combination with vaginal misoprostol. A consecutive seriesof 2000 women requesting early medical abortion at gestationsup to 63 days was studied retrospectively. Each woman receivedmifepristone 200 mg orally, followed 36–48 h later bymisoprostol 800 µg vaginally. Of the 2000 women, 39 (2.0%)aborted completely following administration of mifepristonealone and a further 1912 experienced complete abortion followingadministration of misoprostol (a complete abortion rate of 97.5%).Surgical intervention was required in 49 women (2.5%): for incompleteabortion in 27 (1.4%), for missed abortion in seven (0.4%),for continuing pregnancy in 11 (0.6%) and to exclude ectopicpregnancy in four (0.2%). The surgical intervention rate wassignificantly higher among women at gestations 49 days thanamong those at 49 days (3.3 versus 1.5%, P = 0.0193). The regimenappears as effective, in terms of high complete abortion rateand low continuing pregnancy rate, as any published alternative.This regimen has the benefit of being less costly as the doseof mifepristone is 67% lower and misoprostol is substantiallyless expensive than gemeprost. Additionally, misoprostol doesnot require special transport or storage requirements. As such,the combination of mifepristone and gemeprost.     

Anti-idiotypic IgM antibodies to anti-HLA class I antibodies in habitual abortion.

In order to investigate the role of the idiotypic network in miscarriages, sera from 28 habitually aborting women undergoing paternal leukocyte immunization were studied for the presence of HLA antibodies and related anti-idiotypes. Sixty-eight percent of sera from preimmunized patients which did not contain anti-lymphocyte antibodies inhibited the activity of antibodies to the HLA class I antigens expressed by the spouse. This inhibitory activity could be assigned to IgM antibodies, which cross-inhibit antibodies of similar specificity. This suggests that they are anti-idiotypes for the binding site of HLA antibodies. Immune sera of successfully treated patients exhibited both cytotoxic IgG anti-HLA antibodies and inhibitory IgM anti-idiotypic antibodies. A possible role for an intact idiotypic network in maintaining pregnancy is suggested.     

Structure, genomic DNA typing, and kinetic characterization of the D allozyme of placental alkaline phosphatase (PLAP/ALPP)

The D allozyme of placental alkaline phosphatase (PLAP) displays enzymatic properties at variance with those of the common PLAP allozymes. We have deduced the amino acid sequence of the PLAP D allele by PCR cloning of its gene, ALPP. Two coding substitutions were found in comparison with the cDNA of the common PLAP F allele, i.e., 692C>G and 1352A>G, which translate into a P209R and E429G substitution. A single nucleotide primer extension (SNuPE) assay was developed using PCR primers that enable the amplification of a 1.9 kb PLAP fragment. Extension primers were then used on this PCR fragment to detect the 692C>G and 1352A>G substitution. The SNuPE assay on these two nucleotide substitutions enabled us to distinguish the PLAP F and D alleles from the PLAP S/I alleles. Functional studies on the D allozyme were made possible by constructing and expressing a PLAP D cDNA, i.e., [Arg209, Gly429]PLAP, into wild-type Chinese hamster ovary cells. We determined the k(cat) and K(m), of the PLAP S, F, and D allozymes using the non-physiological substrate p-nitrophenylphosphate at an optimal pH (9.8) as well as two physiological substrates, i.e., pyridoxal-5-phosphate and inorganic pyrophosphate at physiological pH (7.5). We found that the biochemical properties of the D allozyme of PLAP are significantly different from those of the common PLAP allozymes. These biochemical findings suggest that a suboptimal enzymatic function by the PLAP D allozyme may be the basis for the apparent negative selective pressure of the PLAP D allele. The development of the SNuPE assay will enable us to test the hypothesis that the PLAP D allele is subjected to intrauterine selection by examining genomic DNA from statistically informative population samples.     

Patterns of spontaneous unitary discharge in thalamic ventro-basal complex during wakefulness and sleep

Summary Influences of the wake-sleep states on spontaneous activity of thalamic ventro-basal neurons have been studied in the chronic cat using the following analyses for cell discharges: mean firing rate, interspike histogram and joint interval histogram (J.I.H.). While slow wave sleep is accompagnied by a characteristic firing pattern it is more difficult to compare spontaneous unit activity during wakefulness (W) and desynchronised sleep (D).A detailed analysis (especially of the J.I.H.) of the same neuron during the three states indicates marked differences between W and D; on the contrary, the intraburst pattern shows definite similarities between D and S. The greatest stability in the firing pattern of a given neuron is found during S on long recording. During D the variability in the firing pattern is mainly due to phasic activity but may also be related to tonic changes.