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。

Study on the relationship between autoantibodies and diseases of infertility and spontaneous abortion

Objective:To study the role of autoantibodies including anticatcardiolipin antibody(ACA)and antisperm antibody(AsAb)in patients with infertility or spontaneous abortion.Evaluate the clinical effect of aspirin On women with recurrent abortion with positive ACA.Methods:Serum ACA and AsAb were detected by ELISA for 150 women of primary or secondary infertility (infertility group),198 of spontaneous abortion or embryonic diapause (abortion group) and 40 normal women (control group).Lose-dose aspirin was given to 53 women with recurrent abortion with positive ACA before pregnancy or in the first trimester.Results:The positive rates of total ACA in infertility group and abortion group were 48.00% and 50.5 1% respectively,which were very significantly higher than that in control (P<0.001).The positive rates of serum AsAb in infertility group and abortion group were 31.33% and 25.25% respectively,which were significant differences than that in control (P<0.05).In 53 cases treated with aspirin,5 embryo loss occured,and the rate of live birth was 90.57% (48/53).Conclusion:This finding suggests that the autoantibodies as ACA and AsAb play animportant role in the process of infertility and recurrent abortion.The treatment of low-dose aspirin is effective for women with spontaneous abortion with positive ACA.