IVFAustralia, Sydney, Australia.
University of New South Wales, Sydney, Australia.
Am J Reprod Immunol. 2021 Apr;85(4):e13291. doi: 10.1111/aji.13291. Epub 2020 Jul 1.
Natural killer (NK) cell assessment has been attempted since the 1990s and, apart from antibody testing, is probably the commonest immune test available to clinicians. It is clear that simple enumeration of uterine NK cells by immunohistochemistry is inadequate, although better methodology such as flow cytometry may prove to be more beneficial in the future. Blood testing is an appealing noninvasive test that may be a marker for immune dysfunction, rather than a guide to uterine numbers per se. It is currently performed in women with repeated reproductive failure and should be done using tests of activation. Patients value investigation and clinicians should prefer it to blind empirical immune therapy in repeated reproductive failure cases. But, in addition to blood NK testing, a fundamental new NK genetic test (the KIR/HLA-C interaction) is likely to provide an even more effective diagnostic tool. Insights from KIR/HLA-C analysis imply that new immune therapy trials will need to take KIR/HLA-C results into account.
自 20 世纪 90 年代以来，人们一直在尝试评估自然杀伤 (NK) 细胞，除了抗体检测外，这可能是临床医生最常用的免疫检测方法。很明显，免疫组织化学简单地计数子宫 NK 细胞是不够的，尽管更好的方法，如流式细胞术，可能在未来会更有帮助。血液检测是一种有吸引力的非侵入性测试，它可能是免疫功能障碍的标志物，而不是子宫数量本身的标志物。目前，它在反复生殖失败的妇女中进行，应该使用激活测试进行。患者重视检查，临床医生应该在反复生殖失败的情况下，优先选择它而不是盲目进行经验性免疫治疗。但是，除了血液 NK 检测外，一种新的 NK 基因基本检测（KIR/HLA-C 相互作用）可能提供更有效的诊断工具。对 KIR/HLA-C 分析的深入了解表明，新的免疫治疗试验将需要考虑 KIR/HLA-C 结果。
