Hoff C, Peevy K, Giattina K, Spinnato J A, Peterson R D
Department of Pediatrics, College of Medicine, University of South Alabama, Mobile.
Obstet Gynecol. 1992 Dec;80(6):1007-12.
Some studies have found an increased prevalence of pregnancy-induced hypertension among women sharing HLA antigens with their spouses or fetuses, thus supporting the hypothesis that maternal sensitization to fetal HLA alloantigens reduces the risk for pregnancy-induced hypertension. However, not all studies have confirmed these findings. No investigators have examined the four different types of maternal-fetal HLA relationships in their studies of pregnancy-induced hypertension. Our goal was to examine such associations to test further the HLA-allosensitization hypothesis.
We conducted a cohort study of pregnancy-induced hypertension among 683 nulliparous women. Women and their neonates were typed for HLA-A, -B, -DR, and -DQ antigens using serologic techniques to establish maternal-fetal relationships.
We found an increased prevalence of pregnancy-induced hypertension when the fetus, but not the mother, was potentially exposed to HLA-DR alloantigens (maternal allogenicity) compared with the other three conditions combined (P < .003). Controlling for confounding factors, the increased prevalence of pregnancy-induced hypertension persisted in situations of maternal HLA-DR allogenicity (P < .007).
Based upon our observations and other immunologic studies of pregnancy-induced hypertensive and uncomplicated pregnancies, we conclude that a maternal humoral response against fetal anti-HLA-DR immunoglobulin (IgG) antibody may influence the development of pregnancy-induced hypertension. This could occur when an immunocompetent fetus is exposed to maternal HLA-DR alloantigens, maternal exposure to fetal HLA-DR alloantigens alloantigens, maternal exposure to fetal HLA-DR alloantigens is not possible, and fetal IgG antibody bears paternally inherited markers allogeneic to the mother.
一些研究发现，与配偶或胎儿共享HLA抗原的女性中，妊娠高血压的患病率增加，从而支持了这样一种假说，即母体对胎儿HLA同种抗原的致敏作用可降低妊娠高血压的风险。然而，并非所有研究都证实了这些发现。在妊娠高血压的研究中，没有研究者对四种不同类型的母胎HLA关系进行过研究。我们的目标是研究此类关联，以进一步检验HLA同种致敏假说。
我们对683名未生育过的女性进行了一项妊娠高血压队列研究。使用血清学技术对女性及其新生儿进行HLA-A、-B、-DR和-DQ抗原分型，以确定母胎关系。
我们发现，与其他三种情况合并相比，当胎儿而非母亲可能暴露于HLA-DR同种抗原（母体同种异体性）时，妊娠高血压的患病率增加（P < 0.003）。在控制混杂因素后，妊娠高血压患病率的增加在母体HLA-DR同种异体性的情况下仍然存在（P < 0.007）。
基于我们的观察以及其他关于妊娠高血压和正常妊娠的免疫学研究，我们得出结论，母体针对胎儿抗HLA-DR免疫球蛋白（IgG）抗体的体液反应可能会影响妊娠高血压的发展。当具有免疫活性的胎儿暴露于母体HLA-DR同种抗原、母体暴露于胎儿HLA-DR同种抗原、母体不可能暴露于胎儿HLA-DR同种抗原以及胎儿IgG抗体带有与母亲异体的父系遗传标记时，这种情况可能会发生。
