Motak-Pochrzest Hanna, Malinowski Andrzej
The Opole University of Technology, Faculty of Physical Education and Physiotherapy, Opole, Poland.
Department of Operative and Endoscopic Gynaecology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.
Neuro Endocrinol Lett. 2013;34(7):701-7.
The 155 patients suffering from primary RM who took part in this study were qualified after excluding known causes of abortions.
The presence of the following immunological factors was examined in serum samples: autoantibodies such as anti-cardiolipin (ACA) IgG and IgM, lupus-anticoagulant (LA), anti-thyroid (ATA): anti-thyroglobulin (anti-TG) and anti-thyroid peroxydase (anti-TPO), anti-nuclear (ANA), anti-placental (APA) antibodies and alloimmunological disturbances following HLA-class I antibody test (LCT-lymphocytotoxic test), lack of blocking proliferative activity in mixed lymphocyte reaction test (MLR), anti-sperm (ASA) antibodies, levels of extracellular interferon γ (IFN γ) and tumour necrosis α (TNFα) produced by peripheral blood lymphocytes.
Immunological disturbances were found in 69.1% of the patients suffering from primary RM of unknown etiology. The number of RM correlated with the frequency of immunological disturbance. Among the samples from patients who underwent ≥5 RM, positive levels of TNFα were the most frequently observed risk factor (up to 27%) (p=0.05). Although the incidence of immunological factors was comparable between patients with early and late pregnancy losses, elevated ATA levels were frequently seen among late miscarriage (95% CI=36.0, p≤0.01).
The heterogeneity of immunological risk factors shown in this study indicates the usefulness of detecting alloimmune factors as well as autoantibodies in patients with RM of unknown etiology. This may be helpful to analyse the therapeutical effectivity of various treatment in a better characterized group of patients and to explain unsuccessful results of treatment in patients with RM of unknown etiology.
参与本研究的155例原发性复发性流产（RM）患者在排除已知流产原因后符合条件。
检测血清样本中以下免疫因素的存在情况：自身抗体，如抗心磷脂（ACA）IgG和IgM、狼疮抗凝物（LA）、抗甲状腺（ATA）：抗甲状腺球蛋白（抗-TG）和抗甲状腺过氧化物酶（抗-TPO）、抗核（ANA）、抗胎盘（APA）抗体，以及HLA-Ⅰ类抗体检测（LCT-淋巴细胞毒性试验）后的同种免疫紊乱、混合淋巴细胞反应试验（MLR）中缺乏阻断增殖活性、抗精子（ASA）抗体、外周血淋巴细胞产生的细胞外干扰素γ（IFN γ）和肿瘤坏死因子α（TNFα）水平。
在病因不明的原发性RM患者中，69.1%发现有免疫紊乱。RM的次数与免疫紊乱的频率相关。在经历≥5次RM的患者样本中，TNFα阳性水平是最常观察到的危险因素（高达27%）（p = 0.05）。尽管早期和晚期流产患者的免疫因素发生率相当，但晚期流产患者中ATA水平升高较为常见（95%CI = 36.0，p≤0.01）。
本研究中显示的免疫危险因素的异质性表明，在病因不明的RM患者中检测同种免疫因素以及自身抗体是有用的。这可能有助于在特征更明确的患者群体中分析各种治疗的疗效，并解释病因不明的RM患者治疗失败的结果。
