反复自然流产的免疫流行病学研究

目的分析反复自然流产（ＲＳＡ）的免疫病因组成。方法用间接血凝法检测ＡＢＯ血型抗体,用ＢＡ－ＥＬＩＳＡ法检测透明带抗体,用ＥＬＩＳＡ法检测磷脂抗体,以单向混合淋巴细胞反应封闭试验检测封闭效率,通过补体依赖性细胞毒试验测定细胞毒指数,通过单向混合淋巴细胞反应封闭抑制试验分析封闭抗体的抗独特型抗体,利用流式细胞仪分析封闭抗体对ＣＤ抗原的作用。以正常生育组为对照,回顾性分析了１２９例原发性ＲＳＡ及１６例继发性ＲＳＡ的免疫病因构成。结果在ＲＳＡ病因组成中,封闭抗体缺乏占３１．７％,透明带自身抗体占２０．４％,磷脂抗体占１２．５％,ＡＢＯ血型抗体占１１．５％;在原发性流产病因组成中,封闭抗体缺乏占３１．４％,透明带自身抗体占２０．４％,磷脂抗体占８．５％,ＡＢＯ血型抗体占８．４％;在继发性流产中,封闭抗体独特型－抗独特型网络失调占３９．４％,磷脂抗体占３１．４％,ＡＢＯ血型抗体占２２．４％。结论根据ＲＳＡ免疫流行病学分析,ＲＳＡ的病因可以分类为：母－胎免疫识别低下型、母－胎免疫识别过度型及母－胎免疫识别紊乱型。

Immuno-epidemiological investigation of recurrent spontaneous abortion

Objective To probe into immune pathogeny of recurrent spontaneous abortion (RSA). Methods Immunological analysis was made in ABO group antibodies by indirect hemagglutination, anti zona pellucida antibodies by BA ELISA, anti phospholipid antibodies by ELISA, blocking effect (MLR BE) by blocking test one way mixed lymphocyte reaction, cytotoxic index (CI) by complement dependent cytotoxic test, anti idiotypic antibodies to blocking antibodies by MLR BE inhibiting test, and effects of blocking antibodies on CD antigens by flow cytometry. In contrast to the healthy fertile women, 129 cases of primary abortion and 16 cases of secondary abortion were retrospectively analyzed for immunoetiological compositions. Results Among causes of RSA, lack of blocking antibodies accounted for 31.7%, anti zona pellucida antibodies for 20.4%, anti phospholipid antibodies for 12.5%, and ABO group antibodies for 11.5%. Among causes of primary abortion, lack of blocking antibodies accounted for 31.4%, anti zona pellucida antibodies for 20.4%, anti phospholipid antibodies for 8.5%, and ABO group antibodies for 8.4%. Among causes of secondary abortion, imbalance of idiotypic antiidiotypic network of blocking antibody accounted for 39.4%, anti phospholipid antibodies for 31.4%, and ABO group antibodies for 22.4%. Conclusion According to the above evaluation of immuno epidemiology of RSA, RSA may be etiologically classified into lack of materno fetal immuno recognition, materno fetal inappropriate immuno recognition, and disorder of materno fetal immuno recognition.