Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA.
Thromb Res. 2009 Dec;124(6):656-62. doi: 10.1016/j.thromres.2009.07.012. Epub 2009 Aug 14.
Maternal immunity undergoes subtle adjustment in order to tolerate the semi-allogeneic embryo and maintain the host defense against potential pathogens. Concomitantly, coagulation systems change from an anti-coagulant state to a pro-coagulant state to meet the hemostatic challenge of placentation and delivery. Innate immunity and blood coagulation systems are the first line of defense to protect a host against exogenous challenges, including alloantigens and mechanical insults, and preserve the integrity of an organism. The interactions between coagulation and immune systems have been extensively studied. Immune cells play a pivotal role in the initiation of the coagulation cascade, whereas coagulation proteases display substantial immuno-modulatory effects. Upon exogenous challenges, the immune and coagulation systems are capable of potentiating each other leading to a vicious cycle. Natural killer (NK) cells, macrophages (Mphis) and dendritic cells (DCs) are three major innate immune cells that have been demonstrated to play essential roles in early pregnancy. However, immune maladaptation and hemostatic imbalance have been suggested to be responsible for adverse pregnant outcomes, such as preeclampsia (PE), miscarriage, recurrent spontaneous abortion (RSA) and intrauterine growth restriction (IUGR). In this review, we will summarize the mutual regulation between blood coagulation and innate immune systems as well as their roles in the maintenance of normal pregnancy and in the pathogenesis of adverse pregnancy outcomes.
母体免疫会进行微妙的调整，以耐受半同种异体胚胎并维持宿主对潜在病原体的防御能力。同时，凝血系统从抗凝状态转变为促凝状态，以应对胎盘形成和分娩的止血挑战。先天免疫和凝血系统是宿主抵御外源挑战（包括同种异体抗原和机械损伤）的第一道防线，可维持机体的完整性。凝血系统和免疫系统之间的相互作用已得到广泛研究。免疫细胞在凝血级联反应的启动中发挥关键作用，而凝血蛋白酶则具有显著的免疫调节作用。在外源挑战下，免疫和凝血系统能够相互增强，导致恶性循环。自然杀伤 (NK) 细胞、巨噬细胞 (Mphis) 和树突状细胞 (DCs) 是三种主要的先天免疫细胞，它们被证明在早期妊娠中发挥重要作用。然而，免疫失调和止血失衡被认为是导致不良妊娠结局（如子痫前期 (PE)、流产、复发性自然流产 (RSA) 和宫内生长受限 (IUGR)）的原因。在这篇综述中，我们将总结凝血和先天免疫系统之间的相互调节及其在维持正常妊娠和不良妊娠结局发病机制中的作用。
