Takeshita Toshiyuki
Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
J Nippon Med Sch. 2004 Oct;71(5):308-13. doi: 10.1272/jnms.71.308.
Miscarriage is the most common complication of human pregnancy. Although the causes of recurrent miscarriage (RM) are various, immunologic aberrations between mother and fetus might be one of the causes of miscarriage. Immune responses fall into two categories: autoimmune and alloimmune. Currently, no appropriate diagnostic method has been established to identify alloimmune causes. We observed that NK cell activity in women with RM was higher than that in women without a history of miscarriage. Functional or quantitative analysis of NK cells could be used to identify alloimmune causes. Paternal lymphocyte immunization has been the most widely used treatment for alloimmune-mediated miscarriages. However, the latest Cochrane review by Scott reached the current conclusion that lymphocyte immunization therapy provided no significant beneficial effect over placebo in preventing further miscarriage. Approximately 70% of Japanese university hospitals are still performing paternal lymphocyte immunization. Is paternal lymphocyte immunization a relic of the past? Randomized controlled trials based on adequate patient selection in Japan should provide an answer to this question.
流产是人类妊娠最常见的并发症。尽管复发性流产（RM）的病因多种多样，但母胎之间的免疫异常可能是流产的原因之一。免疫反应分为两类：自身免疫和同种免疫。目前，尚未建立合适的诊断方法来识别同种免疫病因。我们观察到，复发性流产女性的自然杀伤（NK）细胞活性高于无流产史的女性。对NK细胞进行功能或定量分析可用于识别同种免疫病因。父淋巴细胞免疫一直是同种免疫介导流产最广泛使用的治疗方法。然而，斯科特最新的Cochrane综述得出当前结论，即淋巴细胞免疫疗法在预防进一步流产方面并不比安慰剂有显著的有益效果。日本约70%的大学医院仍在进行父淋巴细胞免疫。父淋巴细胞免疫是过去的遗物吗？基于日本适当患者选择的随机对照试验应该能回答这个问题。
