Sargent I L, Wilkins T, Redman C W
Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford.
Lancet. 1988 Nov 12;2(8620):1099-104. doi: 10.1016/s0140-6736(88)90522-3.
Direct evidence that maternal immune rejection of the fetus causes some unexplained recurrent spontaneous abortions was sought in 18 women with this condition. Tests of maternal cell-mediated immunity to fetal (paternal) antigens were done before conception, in early pregnancy, and at miscarriage, and were compared with those in 10 controls in their first pregnancies. Maternal cytotoxic alloantibody production and the blocking effect of maternal sera on maternal lymphocyte activation were also evaluated. There was no evidence for maternal cell-mediated reactivity to paternal antigens in normal early pregnancy or in most women who aborted, but circulating cytotoxic cells were found at miscarriage in a third of affected women. There was no correlation between the production of cytotoxic antibodies and serum blocking activity, and the success of the pregnancy. These data provide evidence that cell-mediated immune reactivity may be changed in some women who abort recurrently but show that circulating immunological blocking factors are not relevant to the success of pregnancy. Their induction by maternal immunisation with paternal leucocytes does not explain why this procedure prevents recurrent spontaneous abortions.
在18名患有这种疾病的女性中，寻找母亲对胎儿的免疫排斥导致一些不明原因复发性自然流产的直接证据。在受孕前、妊娠早期和流产时，对母亲针对胎儿（父亲）抗原的细胞介导免疫进行检测，并与10名首次怀孕的对照者进行比较。还评估了母亲细胞毒性同种抗体的产生以及母亲血清对母亲淋巴细胞活化的阻断作用。在正常妊娠早期或大多数流产的女性中，没有证据表明母亲对父亲抗原有细胞介导的反应性，但在三分之一受影响的女性流产时发现了循环细胞毒性细胞。细胞毒性抗体的产生与血清阻断活性以及妊娠成功之间没有相关性。这些数据提供了证据，表明细胞介导的免疫反应性在一些反复流产的女性中可能会发生变化，但表明循环免疫阻断因子与妊娠成功无关。通过用父亲白细胞对母亲进行免疫诱导并不能解释为什么这个程序可以预防复发性自然流产。
