Department of Immunology, St Helier Hospital, Carshalton, Surrey, SM5 1AA, UK.
Expert Rev Clin Immunol. 2011 Jan;7(1):37-44. doi: 10.1586/eci.10.84.
Both organ-specific and systemic autoimmunity are associated with an increased prevalence of recurrent miscarriage (RM). The precise mechanism for this is unclear, as cross-reactivity between trophoblastic and maternal host autoantigens has not been demonstrated. In the antiphospholipid antibody syndrome, prothrombotic mechanisms are evident, along with direct inhibitory actions against trophoblastic activity. In many types of both systemic and organ-specific immunity, however, a disturbed T-helper cell profile is seen. This is also evident in women with RM. In both cases, reduced numbers of T regulatory cells have been reported. These are required to regulate excessive activity of the Th1 and the proinflammatory Th17 subsets that, when operating through excessive natural killer cell activity, may have antipregnancy effects. Checking for underlying autoimmunity is therefore a critical analysis in women with RM and future therapies will probably be aimed at correcting the deficiency of regulatory T cells or correcting excessive Th1 and Th17 function.
器官特异性和全身性自身免疫与复发性流产（RM）的患病率增加有关。其确切机制尚不清楚，因为滋养层和母体自身抗原之间的交叉反应尚未得到证实。在抗磷脂抗体综合征中，存在促血栓形成机制，以及对滋养层活性的直接抑制作用。然而，在许多类型的全身性和器官特异性免疫中，都可以看到辅助性 T 细胞（Th）功能紊乱。RM 患者中也有这种情况。在这两种情况下，报道称调节性 T 细胞（Treg）的数量减少。这些细胞是调节 Th1 和促炎 Th17 亚群过度活性所必需的，当它们通过过度的自然杀伤细胞活性起作用时，可能具有抗妊娠作用。因此，对自身免疫的潜在原因进行检查是 RM 患者的关键分析，未来的治疗方法可能旨在纠正调节性 T 细胞的缺陷，或纠正过度的 Th1 和 Th17 功能。
