Gynaecology and Obstetrics II, Azienda Ospedaliera San Giovanni-Addolorata, Via dell' Amba Aradam 9, 00184 Rome, Italy.
Clin Rev Allergy Immunol. 2010 Dec;39(3):166-75. doi: 10.1007/s12016-009-8184-4.
Infertility and recurrent spontaneous abortion (RSA) are heterogeneous conditions that have been frequently explained with an immunological pathomechanism. A deeper insight into apparently unexplained infertility and RSA shows increasing evidences supporting both alloimmune and autoimmune mechanisms, in which natural killer (NK) cells and autoantibodies seem to play a relevant role. Successful pregnancy is considered as Th1-Th2 cooperation phenomenon, with a predominantly Th2-type lymphocytes response, together with the emerging role of interleukin (IL)-12, IL-15, and IL-18 and of other unidentified soluble factors dependent on NK cells. Uterine NK cells comprise the largest population at implantation site, and their activity, characteristics, and abundance suggest that they participate at the "decidualization" process that, vice versa, induces NK activation and recruitment in each menstrual cycle. However, NK cell alteration may be associated with impaired pregnancy, and the modulation in the number of circulating NK cells is most likely to be a primary event rather than an active inflammation/drug administration consequence during an inflammatory/autoimmune process, thus playing an important role in the pathogenesis of immunological infertility. Relationships within immunological infertility, recurrent spontaneous abortion, autoantibodies, and NK cells will be reviewed herein.
不孕和复发性自然流产（RSA）是具有异质性的疾病，其发病机制常被解释为免疫学因素。对不明原因的不孕和 RSA 的深入研究表明，同种免疫和自身免疫机制均与之相关，其中自然杀伤（NK）细胞和自身抗体似乎发挥着重要作用。成功妊娠被认为是 Th1-Th2 合作现象，表现为以 Th2 型淋巴细胞反应为主，同时白细胞介素（IL）-12、IL-15 和 IL-18 以及其他依赖 NK 细胞的未识别可溶性因子的作用不断凸显。NK 细胞在着床部位的数量最多，其活性、特征和丰度表明其参与了“蜕膜化”过程，反过来，蜕膜化又会在每个月经周期中激活和募集 NK 细胞。然而，NK 细胞的改变可能与妊娠障碍有关，循环 NK 细胞数量的改变很可能是原发性事件，而不是炎症/自身免疫过程中炎症/药物治疗的结果，因此在免疫性不孕的发病机制中发挥着重要作用。本文将对免疫性不孕、复发性自然流产、自身抗体和 NK 细胞之间的关系进行综述。
