Lee Gi Su, Park Joon Cheol, Rhee Jeong Ho, Kim Jong In
Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, Korea.
Obstet Gynecol Sci. 2016 Sep;59(5):379-87. doi: 10.5468/ogs.2016.59.5.379. Epub 2016 Sep 13.
The goal of this study was to evaluate the etiologies and clinical outcomes of Korean recurrent pregnancy loss (RPL) patients. And also, we investigated the differences between primary and secondary RPL patients, between two and three or more pregnancy losses.
One hundred seventy eight women diagnosed as RPL were enrolled. We performed chromosomal analysis, thyroid stimulating hormone, prolactin, blood glucose, plasminogen activator inhibitor-1, natural killer cell proportion, anticardiolipin antibodies, antiphospholipid antibodies, lupus anticoagulant, anti-β2glycoprotein-1 antibodies, antinuclear antibody, protein C, protein S, antithrombin III, homocysteine, MTFHR gene, factor V Leiden mutation, and hysterosalphingography/hysteroscopic evaluation.
The mean age was 34.03±4.30 years, and mean number of miscarriages was 2.69±1.11 (range, 2 to 11). Anatomical cause (13.5%), chromosomal abnormalities (5.6%), and endocrine disorders (34.3%) were observed in RPL women. Elevated natural killer cell and antiphospholipid antibodies were observed in 43.3% and 7.3% each. Among of 178 women, 77 women were pregnant. After management of those women, live birth rate was 84.4% and mean gestational weeks was 37.63±5.12. Women with three or more RPL compared with women with two RPL had more common anatomical cause such as intrauterine adhesions and lower rates of spontaneous pregnancy. Compare with secondary RPL women, immunological abnormalities were more common in primary RPL. However, miscarriage rates were not different.
Immunological factor including autoimmune and alloimmune disorders was most common etiology of RPL. Inherited thrombophilia showed different patterns with other ethnic countries. Miscarriage rates were not different between primary and secondary RPL, or between two and three or more miscarriages group.
本研究旨在评估韩国复发性流产（RPL）患者的病因及临床结局。此外，我们还调查了原发性和继发性RPL患者之间、两次与三次或更多次流产患者之间的差异。
纳入178例被诊断为RPL的女性。我们进行了染色体分析、促甲状腺激素、催乳素、血糖、纤溶酶原激活物抑制剂-1、自然杀伤细胞比例、抗心磷脂抗体、抗磷脂抗体、狼疮抗凝物、抗β2糖蛋白-1抗体、抗核抗体、蛋白C、蛋白S、抗凝血酶III、同型半胱氨酸、MTFHR基因、因子V莱顿突变以及子宫输卵管造影/宫腔镜评估。
平均年龄为34.03±4.30岁，平均流产次数为2.69±1.11次（范围为2至11次）。RPL女性中观察到解剖学原因（13.5%）、染色体异常（5.6%）和内分泌紊乱（34.3%）。自然杀伤细胞和抗磷脂抗体升高的分别占43.3%和7.3%。在178名女性中，77名女性怀孕。对这些女性进行治疗后，活产率为84.4%，平均孕周为37.63±5.12。与两次RPL的女性相比，三次或更多次RPL的女性有更常见的解剖学原因，如宫腔粘连，且自然受孕率较低。与继发性RPL女性相比，原发性RPL中免疫异常更为常见。然而，流产率并无差异。
包括自身免疫和同种免疫疾病在内的免疫因素是RPL最常见的病因。遗传性血栓形成倾向与其他国家人群表现出不同模式。原发性和继发性RPL之间，以及两次与三次或更多次流产组之间的流产率并无差异。
