Scott J R, Rote N S, Branch D W
Obstet Gynecol. 1987 Oct;70(4):645-56.
Although mechanisms that prevent rejection of the conceptus are incompletely understood, recent evidence suggests that maternal immunologic aberrations may cause repeated abortions. Autoimmune conditions associated with antiphospholipid antibodies sometimes produce vascular abnormalities in the decidua and placenta; successful pregnancies can be achieved in most of these women by treatment with corticosteroids and low-dose aspirin. Abnormal maternal immune responses to paternal or trophoblast alloantigens, with insufficient production of blocking antibodies or suppressor cells, have also been implicated. Immunization of these patients with paternal or third-party leukocytes has resulted in a number of live births. However, the mechanism of action, effectiveness, and safety of all treatment regimens remain controversial. Present recommendations for the evaluation of recurrent-abortion patients include diagnosis and appropriate treatment of traditional nonimmunologic and more recently recognized autoimmune factors. The remaining patients with no detectable cause for repetitive pregnancy loss are candidates for referral to research centers for further immunologic evaluation and experimental immunotherapy.
尽管阻止胚胎被排斥的机制尚未完全明了，但最近的证据表明，母体免疫异常可能导致反复流产。与抗磷脂抗体相关的自身免疫性疾病有时会在蜕膜和胎盘中产生血管异常；大多数这类女性通过使用皮质类固醇和小剂量阿司匹林治疗可成功受孕。母体对父方或滋养层同种异体抗原的异常免疫反应，以及阻断抗体或抑制细胞产生不足，也被认为与之有关。用父方或第三方白细胞对这些患者进行免疫已导致多例活产。然而，所有治疗方案的作用机制、有效性和安全性仍存在争议。目前对反复流产患者评估的建议包括对传统非免疫性因素以及最近认识到的自身免疫性因素进行诊断和适当治疗。其余没有可检测到的反复妊娠丢失原因的患者可被转诊至研究中心进行进一步的免疫学评估和实验性免疫治疗。
