夫妇HLA-DR抗原相容性与习惯性流产的关系

目的探讨夫妇HLA-DR抗原相容性和习惯性流产的关系。方法采集2007年8月—2009年8月在我院就诊的30对习惯性流产夫妇外周血,各5 ml,以同时期正常妊娠夫妇作为对照组,抽提样本基因组DNA,确定HLA-DR等位基因位点及其对应抗原,分析疾病组与对照组中抗原相容性分布是否具有差异。结果在检出的DR抗原中,两组抗原频率差别无统计学意义（P〉0.05）。疾病组中,有6对（20%）夫妇HLA-DR抗原零相容,18对（60%）夫妇一个抗原相容,6对（20%）夫妇两个抗原相容。对照组中,21对（70%）夫妇零相容,7对（23%）夫妇一个抗原相容,2对（7%）夫妇两个抗原相容。两组夫妇抗原相容性分布有显著性差异（P〈0.01）。一个抗原相容对于零抗原相容的相对危险度（RR）为9,两个抗原相容相对于零抗原相容的相对危险度（RR）为10.5。结论习惯性流产的发生与免疫失衡有关,夫妇双方HLA-DR抗原相容性增加,致母体对异体抗原识别不足,不能产生足够的封闭性抗体,胚胎遭排斥而产生流产。

Relationship between couple's compatibility of HLA-DR and recurrent spontaneous abortion

Objective To study the relationship between couple＇s compatibility of human leukocyte classⅡDR antigens（HLA-DR） and recurrent spontaneous abortion.Methods Thirty women with recurrent spontaneous abortion and 30 healthy pregnant women and their partners were enrolled from August 2007 to August 2009.Aliquots of 5 ml venous blood samples were taken in ethylenediamine tetraacetic acid solution tubes.Genomic DNA was extracted,then HLA-DR gene and antigen were typed and analyzed between two groups.Results HLA-DR typing did not show any particular antigen clearly associated with recurrent spontaneous abortion（P0.05）.In study group,6 couples（20%） had zero compatible HLA-DR antigen,18 couples（60%） had one compatible HLA-DR antigen,6 couples（20%） had two compatible HLA-DR antigens.In control group,21 couples（70%） had zero compatible HLA-DR antigen,7 couples（23%） had one compatible HLA-DR antigen,2 couples（7%） had two compatible HLA-DR antigens（P0.01）.The antigen compatibility in study group was higher than controls.The relative risk of one compatible HLA-DR antigen was 9,the relative risk of two compatible HLA-DR antigens was 10.5.Conclusion Increased HLA-DR antigen compatibility between father and mother might contribute to recurrent spontaneous abortion as a result of an impaired ability to generate a protective maternal immune response.It leads to the failure of the mother＇s nonresponsiveness to fetal antigen.Lack of blocking factor increases the risk for recurrent spontaneous abortion.