Jerzak Małgorzata, Rechberger Tomasz, Baranowski Włodzimierz, Semczuk Marian
Kliniki Połoznictwa i Patologii Ciazy AM w Lublinie.
Ginekol Pol. 2003 Oct;74(10):1107-11.
Recent data emphasize relationship between antiphospholipid antibodies (APA) and increased natural killer cell activity in women with recurrent spontaneous abortion (RSA). Therefore, it has been proposed that final common mechanism involved in the pathogenesis of RSA is associated with auto- and alloimmunity.
The aim of this study was to present our data concerning diagnosis and treatment of women with RSA.
Sixty nonpregnant women with the history of RSA were studied, among them 41 were screened at the beginning of their next pregnancy. We investigated the existence of inherited (deficiencies of protein C, protein S, antithrombin III, a resistance to the activated protein C-including Leiden V mutation) or acquired thrombophilia (APA-anticardiolipin antibodies, antiphosphatidylserine antibodies, lupus anticoagulant). Natural killer cell activity was measured using flow cytometry. In addition, the following lymphocytes surface antigens: CD3, CD4, CD8, CD16, CD56 were studied using flow cytometry. We also studied the existence of autoimmunity: antinuclear antibodies (ANA), antithyroid antibodies (ATA). According to presence of auto- or alloimmunity, we introduce immunotherapy: intravenous immunoglobulin, alloimmunization, heparin/aspirin, aspirin alone, steroids or combine therapy.
We determined the existence of thrombophilia in 17 women, ANA in 5 women, ATA in 5 women, increased number of NK cells in 16 women and increased NK cell activity in 14 women. Forty-one women were pregnant and followed up during pregnancy, among them 33/41 delivered normal healthy baby, 7/41 experienced the next abortion and 1/41 had ectopic pregnancy. Therefore, overall success of immunotherapy was 80.5%.
Immunotherapy seems to be effective treatment for women with the history of RSA and combined immune abnormalities. Regulation of immune system activity may underlie possible effect of such therapy.
近期数据强调了抗磷脂抗体（APA）与复发性自然流产（RSA）女性自然杀伤细胞活性增加之间的关系。因此，有人提出RSA发病机制中涉及的最终共同机制与自身免疫和同种免疫有关。
本研究的目的是展示我们关于RSA女性诊断和治疗的数据。
研究了60例有RSA病史的未孕女性，其中41例在下次妊娠开始时进行了筛查。我们调查了遗传性（蛋白C、蛋白S、抗凝血酶III缺乏，对活化蛋白C的抵抗——包括莱顿V突变）或获得性血栓形成倾向（APA——抗心磷脂抗体、抗磷脂酰丝氨酸抗体、狼疮抗凝物）的存在情况。使用流式细胞术测量自然杀伤细胞活性。此外，使用流式细胞术研究了以下淋巴细胞表面抗原：CD3、CD4、CD8、CD16、CD56。我们还研究了自身免疫的存在情况：抗核抗体（ANA）、抗甲状腺抗体（ATA）。根据自身免疫或同种免疫的存在情况，我们采用免疫疗法：静脉注射免疫球蛋白、同种免疫、肝素/阿司匹林、单独使用阿司匹林、类固醇或联合治疗。
我们确定17名女性存在血栓形成倾向，5名女性存在ANA，5名女性存在ATA，16名女性自然杀伤细胞数量增加，14名女性自然杀伤细胞活性增加。41名女性怀孕并在孕期接受随访，其中33/41分娩出健康正常婴儿，7/41再次流产，1/41发生异位妊娠。因此，免疫疗法的总体成功率为80.5%。
免疫疗法似乎是治疗有RSA病史且合并免疫异常女性的有效方法。免疫系统活性的调节可能是这种疗法产生可能效果的基础。
