淋巴细胞免疫疗法及其在复发性自然流产女性维持妊娠中的可能机制。
Lymphocyte immunotherapy and its probable mechanism in the maintenance of pregnancy in women with recurrent spontaneous abortion.
作者信息
Pandey Manoj Kumar, Thakur Seema, Agrawal Suraksha
机构信息
Molecular Medicine Program, Guggenheim 18, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
出版信息
Arch Gynecol Obstet. 2004 Mar;269(3):161-72. doi: 10.1007/s00404-003-0560-3. Epub 2003 Dec 2.
INTRODUCTION
Most women with alloimmune cause of recurrent spontaneous abortion (RSA) includes increased sharing of human leukocyte antigens (HLA) that may prohibit the mother from making anti-paternal cyto-toxic antibodies (APCA), anti-idiotypic antibodies (Ab2) and mixed lymphocyte reaction blocking antibodies (MLR-Bf). Overactivity of T helper-1 (Th-1) cytokines and natural killer (NK) cells have been also reported to be the major alloimmune cause of recurrent spontaneous abortion (RSA). It was revealed from extensive updated analysis of this subject that paternal lymphocytes immunotherapy may play a significant role in the prevention of alloimmune cause of fetal loss in women with RSA. These alloimmune parameters are found to be suppressed in successful immunotherapy, which is comparable to normal pregnancy.
REVIEW AND DISCUSSION
Various studies represented that paternal lymphocyte immunotherapy was attributed to the high expression of APCA, Ab2, MLR-Bf and inhibition of Th-1 pattern of cytokines and NK cell activity in women with alloimmune cause of RSA. Present updated randomized clinical trials demonstrated that women with RSA of study group who have been treated with paternal lymphocyte immunotherapy had more successful outcomes (68%) as compared to women with RSA of control group who either received autologous lymphocytes/third party lymphocytes/normal saline or no therapy (54%), ( p<0.02). However, when the results of the randomized and nonrandomized studies were pooled together it was observed that 67% of women with RSA of study group who received paternal lymphocyte immunotherapy showed successful pregnancy outcome in comparison to 36% success in women with RSA of control group who either received autologous lymphocytes/third party lymphocytes/normal saline or no therapy ( p<0.05).
CONCLUSION
These results advocate the role of paternal lymphocyte immunotherapy for the maintenance of pregnancy in women with RSA.
引言
大多数因同种免疫导致复发性自然流产（RSA）的女性存在人类白细胞抗原（HLA）共享增加的情况，这可能会阻止母亲产生抗父本细胞毒性抗体（APCA）、抗独特型抗体（Ab2）和混合淋巴细胞反应阻断抗体（MLR - Bf）。也有报道称，辅助性T细胞1（Th - 1）细胞因子和自然杀伤（NK）细胞的过度活跃是复发性自然流产（RSA）的主要同种免疫原因。对该主题的广泛更新分析表明，父本淋巴细胞免疫疗法在预防RSA女性因同种免疫导致的胎儿丢失方面可能发挥重要作用。在成功的免疫疗法中，这些同种免疫参数会受到抑制，这与正常妊娠相当。
综述与讨论
各种研究表明，父本淋巴细胞免疫疗法可使因同种免疫导致RSA的女性体内APCA、Ab2、MLR - Bf高表达，并抑制细胞因子的Th - 1模式和NK细胞活性。目前更新的随机临床试验表明，接受父本淋巴细胞免疫疗法治疗的研究组RSA女性的成功妊娠率（68%）高于接受自体淋巴细胞/第三方淋巴细胞/生理盐水或未接受治疗的对照组RSA女性（54%），（p<0.02）。然而，将随机和非随机研究的结果汇总后发现，接受父本淋巴细胞免疫疗法的研究组RSA女性中有67%获得成功妊娠，而接受自体淋巴细胞/第三方淋巴细胞/生理盐水或未接受治疗的对照组RSA女性的成功率为36%（p<0.05）。
结论
这些结果支持父本淋巴细胞免疫疗法在维持RSA女性妊娠中的作用。
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