丙种球蛋白被动免疫治疗原因不明性反复自然流产研究

目的:探讨静脉点滴丙种球蛋白治疗原因不明性反复自然流产(URSA)的疗效及治疗前后机体封闭抗体、T细胞亚群、胞内Th1/Th2细胞因子及外周血NK细胞含量的变化,以期初步阐明其治疗机理。方法:URSA患者治疗前均检测封闭抗体,对于封闭抗体阴性的患者给予每2周静脉点滴10g国产丙种球蛋白,连续4次治疗后再次检测封闭抗体。怀孕后改为每3周同剂量加强免疫一次,至怀孕26～30周。应用FACSCalibur流式细胞仪分析25例患者治疗前后外周血T淋巴细胞亚群、胞内Th1/Th2细胞因子及NK细胞的变化,并选择20例正常妊娠并选择人工流产者作为对照组。结果:25例URSA经4次被动免疫治疗后有19例封闭抗体转阳性。21例能正常怀孕并成功分娩,4例流产,成功率84%。治疗后CD3+T细胞百分比略升高但无显著性差异;CD8+T细胞百分比有明显升高;而CD4+T细胞百分比明显下降;CD4+/CD8+比率也明显下降。胞内Th2型细胞因子IL-10含量显著性升高;胞内Th1型细胞因子IFN-γ和外周血NK细胞含量明显下降。结论:静脉点滴丙种球蛋白治疗URSA具有较好疗效。治疗后机体免疫保护作用明显增强,可能是丙种球蛋白促进妊娠发展的原因之一。

The treatment of unexplained recurrent spontaneous abortion women with intravenous immunoglobulin

Objective:To investigate the effectiveness and the changes of blocking antibody,T lymphocyte subpopulations,intracellular Th1/Th2 cytokines and NK cell percentage of treatment with intravenous immunoglobulin in unexplained recurrent spontaneous abortion women.Methods:25 women were received treatment with immunoglobulin at a dose of 10 g within 2 weeks for 4 times before pregnancy.Once conception was achieved,immunoglobulin treatment was continued on 3 monthly basis at same dose within 3 weeks through 26~30 weeks of gestation.Flow cytometry was used to measure T lymphocyte subpopulations and intracellular Th1/Th2 cytokines and NK cell percentage of all women participants with RSA.Results:Of 25 women continued immunoglobulin treatment through 26~30 weeks of gestation,there are 19 CDC positive after immunotherapy,21(84%)had a successful term pregnancy.We have also observed immunized women with RSA showed significantly increased percentage of CD4+ cells,CD4+/CD8+ ratio,intracellular IL-10,and significantly decreased percentage of CD8+ cells,intracellular IFN-γ and NK cell percentage as compared to before immunotherapy.Conclusion:The treatment of unexplained recurrent spontaneous abortion women with intravenous immunoglobulin is effective and useful for pregnancy development.