Lee Sung Ki, Kim Jee Yun, Han Ae Ra, Hur Sung Eun, Kim Chul Jung, Kim Tae Hyun, Cho Bo Ra, Han Jae Won, Han Sae Geul, Na Baeg Ju, Kwak-Kim Joanne
Department of Obstetrics and Gynecology, Konyang University Hospital, Daejeon, Korea.
Seoul Metropolitan Seobuk Hosptial, Seoul, Korea.
Am J Reprod Immunol. 2016 Jan;75(1):59-68. doi: 10.1111/aji.12442. Epub 2015 Oct 29.
We investigated the therapeutic effect of intravenous immunoglobulin (IVIG) in women with recurrent pregnancy loss (RPL).
This was a retrospective observational study. Total 189 RPL women who experienced ≥2 miscarriages were enrolled and investigated conventional etiologies, thrombophilia, and cellular immunity. Patients were divided into four groups; known etiology with (Gr1) and without cellular immune abnormality (Gr2), unknown etiology with (Gr3) and without cellular immune abnormality (Gr4). IVIG was administrated from early pregnancy to 30 weeks of gestation to women with cellular immune abnormality (Gr1 + Gr3).
Cellular immune abnormalities (increased level or cytotoxicity of NK cells and Th1/Th2 ratio) were present in 111 of 189 RPL women (58.7%). Live birth rates of women with and without cellular immune abnormality were not different (Gr1 + Gr3, 84.8% versus Gr2 + Gr4, 89.7%). Furthermore, IVIG success rates were the same between Gr1 and Gr3, those who had cellular immune abnormality. Nevertheless lack of an appropriate control in this study, our IVIG outcome demonstrated better live birth rate compared with those of other investigators.
Treatment modalities stratified by underlying etiologies of RPL may improve pregnancy outcome. Administration of IVIG is likely to have clinical efficacy in RPL women with cellular immune abnormality.
我们研究了静脉注射免疫球蛋白（IVIG）对复发性流产（RPL）女性的治疗效果。
这是一项回顾性观察研究。共纳入189例经历过≥2次流产的RPL女性，调查其传统病因、血栓形成倾向和细胞免疫情况。患者被分为四组：有已知病因且有（第1组）和无（第2组）细胞免疫异常的，有未知病因且有（第3组）和无（第4组）细胞免疫异常的。对有细胞免疫异常的女性（第1组 + 第3组）从孕早期至妊娠30周给予IVIG治疗。
189例RPL女性中有111例（58.7%）存在细胞免疫异常（自然杀伤细胞水平或细胞毒性增加以及Th1/Th2比值异常）。有和无细胞免疫异常的女性活产率无差异（第1组 + 第3组为84.8%，第2组 + 第4组为89.7%）。此外，第1组和第3组有细胞免疫异常的患者IVIG成功率相同。尽管本研究缺乏合适的对照，但我们的IVIG治疗结果显示活产率优于其他研究者。
根据RPL潜在病因分层的治疗方式可能改善妊娠结局。IVIG给药可能对有细胞免疫异常的RPL女性具有临床疗效。
