上海交通大学学报（医学版）

›› 2009, Vol. 29 ›› Issue (11): 1275-.

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免疫型复发性流产的发病机制及诊断和治疗

林其德, 邱丽华   

  1. 上海交通大学 医学院仁济医院妇产科, 上海 200127
  • 出版日期:2009-11-25 发布日期:2009-11-24

Pathogenesis, diagnosis and treatment of recurrent spontaneous abortion with immune type

LIN Qi-de, QIU Li-hua   

  1. Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
  • Online:2009-11-25 Published:2009-11-24

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摘要：

复发性流产（RSA）是临床上难以处理的不育症，发病率占妊娠总数的1%~5%。在从20世纪80年代末开始的针对RSA免疫发病机制与临床诊治的系统性研究过程中，发现RSA的发生与患者系统免疫和局部免疫异常有关，其中自身免疫型RSA主要与抗磷脂抗体（APA）阳性有关，而同种免疫型RSA则与母胎免疫耐受失衡有关。建立了系统的免疫型RSA病因筛查流程和诊断体系，其中在国际上首创的ACL＋β2-GP1双指标联合多次检测技术为免疫型RSA的分型诊断提供了有效手段；结合孕前和孕期临床多指标动态监测，在国际上首创小剂量、短疗程、个体化的免疫抑制和淋巴细胞主动免疫治疗，并对接受免疫治疗患者的子代进行随访，验证了该疗法的安全性和有效性。该项研究成果解决了长期以来困扰临床医师的RSA病因诊断难、治疗难等问题，极大地提高了我国RSA的诊治水平。

关键词: 复发性流产, 自身免疫型, 同种免疫型, 发病机制, 诊断, 免疫治疗

Abstract:

Recurrent spontaneous abortion (RSA), which affects 1% to 5% of women of reproductive age,  is difficult to treat in the clinical setting. In the investigations of immunopathogenesis, diagnosis and treatment of RSA since the late 1980s, it was found that RSA was associated with abnormal maternal local or systemic immune response, the pathogenesis of autoimmune RSA was mainly associated with antiphosphlipid antibody (APA）, while that of alloimmune RSA was due to the disturbance of maternofetal immunological tolerance. Systemic etiological screening process and diagnosis systems of RSA with immune type were developed, and anticardiolipin (ACL)+β2-GP1 combining multiple assay for effective diagnosis of RSA with immune type was initially established. According to dynamic monitoring clinical parameters before and during gestation, low-dose, short-course and individual immunosuppressive therapy and lymphocyte immunotherapy for RSA with immune type were initiated. The outcomes of the offsprings of patients with RSA were followed up, and the safety and validity of the therapies were confirmed. The research achievement leads to great progress in the diagnosis and treatment of RSA in China.

Key words: recurrent spontaneous abortion, autoimmune, alloimmune, pathogenesis, diagnosis, immunotherapy