复发性流产的免疫机制和药物治疗进展

复发性流产(Recurrent spontaneous abortion,RSA)是指妊娠140 d之前两次及以上的自然流产,发病几率逐年升高,其发病原因复杂,包括子宫畸形、激素和代谢紊乱、感染因素、抗磷脂综合症以及细胞遗传学变异等,但是40%~60%的复发性流产的发病机制尚不明确,对其免疫机制的研究是近年来的研究重点。生殖免疫学认为妊娠是一种半同种移植过程,母-胎界面的免疫耐受可以维持妊娠的继续,打破这种免疫耐受会导致复发性流产的发生。复发性流产的免疫发生机制主要与抗磷脂抗体、自然杀伤细胞、调节性T细胞、滤泡辅助性T细胞以及细胞因子有关,对其进行免疫调节治疗可以降低流产率。文章对RSA的免疫机制的研究和药物治疗提供系统性的总结,包括抗凝血药物、免疫疗法、激素疗法和干细胞疗法等。

The Immune-Mediated Pathogenesis and Drug Treatment Updates of Recurrent Spontaneous Abortion

Recurrent spontaneous abortion is defined as the spontaneous loss of 2 or more clinical pregnancy before 140 days completed weeks of gestationalage.The incidence of recurrent spontaneous abortion is increasing year by year.The pathogenesis of recurrent spontaneous abortion is complex,including uterine malformations,hormonal and metabolic disorders,infection factors,antiphospholipid syndrome and cytogenetic variation.However,40%~60%of the pathogenesis of recurrent abortion still was not clear.Recent researches focused on the study of its immune mechanism.Reproductive immunology believes that pregnancy is a semi-allogeneic transplantation process and the immune tolerance at the maternal-fetal interface can maintain the pregnancy.Once this pattern of immune tolerance is broken,it will lead to the occurrence of unexplained recurrent spontaneous abortion.The immune mechanism of unexplained recurrent spontaneous abortion was mainly related to antiphospholipid antibodies,natural killer cells,regulatory T cells,follicular helper T cells and cytokines.Immunomodulatory treatments have therefore been proposed for women with unexplained recurrent spontaneous abortion to reduce the rate of abortion.Here,a systematic summary of the study of immune mechanism and drug therapy of recurrent spontaneous abortion had been provided,including anticoagulant drugs,immunotherapy,hormone therapy and stem cell therapy.