Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
Key Laboratory of Maternal-Fetal Medicine, China Medical University, Shenyang, China.
Am J Reprod Immunol. 2020 Apr;83(4):e13225. doi: 10.1111/aji.13225. Epub 2020 Feb 7.
To determine whether patients with unexplained recurrent pregnancy loss (URPL) can benefit from pre-conception immunotherapy or on the early phase of the first trimester.
The prospective follow-up study which involved pre-conception patients diagnosed with URPL following rigorous etiology screening in the medical center of recurrent pregnancy loss. In this study, pre-conception immunotherapy included lymphocyte immunotherapy (pre-LIT). Post-conception immunotherapy (post-IM) included LIT or intravenous immunoglobulin (IVIG). Patients were recommended to undergo post-IM immediately from human chorionic gonadotrophin (hCG) elevation. Autoimmune antibodies (AIA) and anti-paternal lymphocytotoxic antibodies (APLA) were tested before and after pre-LIT. Favorable outcome was defined as pregnancy over 14 weeks. Unfavorable outcomes included biochemical pregnancy loss (BPL) and pregnancy loss with clear implantation location (PLCIL).
In this study, URPL accounted for 12.9% of recurrent pregnancy loss (217/1682). Frequency of BPL was significantly lower in patients with post-IM than that without post-IM [2.8% vs 28.2%; adjusted relative risk (aRR), 0.06; 95% confidence interval (CI), 0.01-0.24]. There was a significant positive conversion in the AIA induced by pre-LIT (0.0% vs 31.0%). Frequency of PLCIL in patients with positive iatrogenic AIA conversion induced by pre-LIT was higher than that in patients without AIA conversion [30.4% vs 5.8%; aRR, 7.53; 95% CI, 1.31-43.34].
Pre-LIT of patients with URPL contributed to a positive iatrogenic AIA conversion, which was associated with an increased risk of PLCIL. Post-IM immediately initiated from the time of hCG elevation can reduce the incidence of BPL.
确定不明原因复发性妊娠丢失（URPL）患者是否能从孕前免疫治疗或孕早期获益。
这是一项前瞻性随访研究，纳入了在复发性妊娠丢失医学中心经过严格病因筛查后诊断为 URPL 的孕前患者。在这项研究中，孕前免疫治疗包括淋巴细胞免疫治疗（pre-LIT）。孕后免疫治疗（post-IM）包括 LIT 或静脉注射免疫球蛋白（IVIG）。一旦 hCG 升高，即建议患者进行 post-IM。在 pre-LIT 前后检测自身免疫抗体（AIA）和抗父系淋巴细胞毒性抗体（APLA）。妊娠超过 14 周定义为良好结局。不良结局包括生化妊娠丢失（BPL）和有明确着床位置的妊娠丢失（PLCIL）。
在这项研究中，URPL 占复发性妊娠丢失的 12.9%（217/1682）。与未进行 post-IM 的患者相比，进行 post-IM 的患者的 BPL 发生率明显更低[2.8% vs 28.2%；调整后的相对风险（aRR），0.06；95%置信区间（CI），0.01-0.24]。pre-LIT 诱导的 AIA 阳性转化率显著升高（0.0% vs 31.0%）。pre-LIT 诱导的 AIA 阳性转化率与 PLCIL 发生率呈正相关，阳性转化率高的患者发生 PLCIL 的风险更高[30.4% vs 5.8%；aRR，7.53；95%CI，1.31-43.34]。
URPL 患者的 pre-LIT 有助于诱导产生医源性 AIA 阳性转化率，这与 PLCIL 风险增加相关。hCG 升高时立即开始孕后免疫治疗可降低 BPL 的发生率。
