自身抗体对体外受精——胚胎移植结果影响的研究

目的研究自身抗体对体外受精-胚胎移植(IVF-ET)结果的影响.方法采用酶联免疫吸附法(ELISA)对2001年9月～2002年8月共164个IVF-ET周期中女性血清中抗心磷脂抗体免疫球蛋白G,M(ACAbIg-G,M)、抗精子抗体(AsAb)和抗卵巢抗体(AOAb)进行测定,同时观察IVF-ET周期妊娠结局.结果 31个ACAb阳性周期中妊娠率为12.90%(4/31),明显低于133个抗体阴性的33.08%(44/133),二者差异有显著性(P＜ 0.05);18个AsAb阳性周期的妊娠率为27.78%(5/18),与146个抗体阴性的周期的妊娠率30.82%(45/146)相比较二者差异无显著性(P＞0.05).在19个AOAb抗体阳性周期中,妊娠率为10.53%(2/19),明显的低于145个抗体阴性周期的31.72%(46/145)(P＜0.05),二者比较差异有显著性.在上述三种抗体中,体内只有一种抗体存在的病人,妊娠率为20.83%(10/48),明显低于无任何抗体存在者的妊娠率36.27%(37/102)(P＜0.05).存在二种抗体者的妊娠率为8.33%(1/12),与前两者相比差异有显著性.而体内存在三种抗体的病人,其妊娠率为0%(0/2).结论女性患者体内ACAb可能干扰了IVF-ET中胚胎着床.AsAb主要影响精子的运输,而对受精卵的着床及发育关系不大.AOAb通过干扰卵裂后的胚胎成熟导致移植失败.

Study on the effect of the autoantibodies on the outcome of in vitro fertilization-embryo transfer

Objective To study the effect of autoantibodies on the outcome of in vitro fertilization-embryo tranefer (IVF-ET). Methods Levels of sera anticardiolipin antibody immunoglobulin G,M (ACAb IG-G,M) antisperm antibody (AsAb) and antiovarian antibody (AOAb) were determined by enzyme-linked immunosorbent assay (ELISA) in 164 treatment cycles with IVF-ETand the pregnant rates were analyzed. Results Lower pregnantrate was found in 31 cycles with ACAb than in 133 cycles without ACAb (12 90% vs 33 08%, P <0 05). The pregnant rate was 27 78% in 18 cycles of seropositive AsAb and 30 82% in 146 cycles of seronegative ( P >0 05). Pregnant rate in 19 cycle of AOAb seropositive women was lower than in 145 cycles of AOAb seronegative women (10 53% vs. 31 72%, P <0 05). The pregnant rate of women with one of autoantibodies was lower than without any of the autoantibodies (20 83% vs. 36 27%, P <0 05). Women with two of the autoantibodies presented lower pregnant rate (8 33%,1/12) than either group without or with one autoantibody. The pregnancy rate of women with three autoantibodies was 0% (0/2). Conclusions ACAb in women may disturb the embryo nidation in IVF-ET. ASAb in women may mainly affect the transportation of sperms,rather than nidation or development of fertilized egg. AOAb in female patients may through disturb postcleavage maturation of embryo and induce the failure of IVF-ET.