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[不明原因复发性流产的管理。免疫疗法是一种选择吗?]

[The management of unexplained recurrent abortions. Is immunotherapy an option?].

作者信息

Constantinescu Daniela, Cozmei Carmen, Dumitraşcu Irina, Carasevici E

机构信息

Institutul de Sănătate Publică Iaşi, Universitatea de Medicina si Farmacie Gr T Popa Iaşi.

出版信息

Rev Med Chir Soc Med Nat Iasi. 2008 Apr-Jun;112(2):371-8.

Abstract

Recurrent abortions, defined as more than three consecutive pregnancy losses, are associated with genetic, anatomic and endocrine causes. Whenever investigations fail to detect a cause, immunological dysfunctions are incriminated. The paper shortly reviews the main causes, investigation protocols and immune therapeutic attempts that have been made. Active immunization with allogenic leukocytes or trophoblastic membranes, passive immunization with intravenous immunoglobulins and immunomodulation with glucocorticoids in unexplained recurrent abortions generated contradictory results and was banned by reproductive immunology scientists as empirical, risky for the mother and harmful for the fetus. Confronted with desperate couples, clinicians use the immunotherapy with paternal lymphocytes or intravenous immunoglobulins in healthy women with unexplained recurrent abortions or in cases where accepted therapies failed.

摘要

复发性流产定义为连续三次以上妊娠丢失,与遗传、解剖和内分泌原因有关。当检查未能发现病因时,免疫功能障碍就被视为病因。本文简要回顾了主要病因、检查方案以及已进行的免疫治疗尝试。在不明原因的复发性流产中,用同种异体白细胞或滋养层细胞膜进行主动免疫、用静脉注射免疫球蛋白进行被动免疫以及用糖皮质激素进行免疫调节产生了相互矛盾的结果,生殖免疫学家认为这些方法缺乏依据、对母亲有风险且对胎儿有害,因此已被禁止。面对绝望的夫妇,临床医生会在不明原因复发性流产的健康女性中或在接受的治疗失败的情况下,使用父亲淋巴细胞或静脉注射免疫球蛋白进行免疫治疗。

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