Chen Jiao, Liu Bowen, Zhang Ying, Ao Liangfei, Li Zehong, Qu Bing, Li Xueyao, Yang Jing
Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Clinical Research Center for Assisted Reproductive and Embryonic Development, Wuhan, China.
Ann Palliat Med. 2020 Sep;9(5):2545-2550. doi: 10.21037/apm-19-440b. Epub 2020 Aug 7.
At present, it is generally believed that immune factors account for 60% of unexplained recurrent spontaneous abortion (URSA). The treatments used for URSA depend on immunomodulation for their effects, and paternal immunization, intravenous immunoglobulin, and the use of growth factors such as granulocyte-colony stimulating factor (filgrastim) have been shown to have a beneficial effect on patients with a poor prognosis. However, these treatment schemes and effects remain controversial. This study aimed to evaluate the effect of immunotherapy using lymphocyte active immunotherapy (LAI) on patients with URSA, and to provide evidences for the clinical effect of this treatment.
The detailed data of total 619 patients with URSA were collected and analyzed, of which 465 patients (LAI group) with immunotherapy and 154 patients (control group) without immunotherapy.
After 77.6% of all the patients in LAI group received the immunotherapy, the maternal blocking antibody (BA) was changed from negative to positive. The conversion rate of maternal BA was increased as the increase of active immunization (>4 times, P<0.05). The pregnancy rate of LAI Group was higher than that of the control group (P<0.05), and there were significant differences of live rate and abortion rate (P<0.05). In addition, compared with the natural pregnancy, the live rate was higher, and the abortion rate was lower in in vitro fertilization (IVF) patients after active immunization, although the difference was not significant (P>0.05).
After lymphocyte immunotherapy, most of the patients with unexplained recurrent spontaneous abortion had the positive BA instead of negative BA. Whether the BA was converted or not, the pregnancy rate and live rate were increased, and the abortion rate was decreased after immunotherapy. Therefore, active immunotherapy could improve the pregnancy outcome of the patients with unexplained recurrent abortion.
目前，普遍认为免疫因素占不明原因复发性自然流产（URSA）的60%。用于URSA的治疗依赖免疫调节发挥作用，父方免疫、静脉注射免疫球蛋白以及使用粒细胞集落刺激因子（非格司亭）等生长因子已被证明对预后不良的患者有有益作用。然而，这些治疗方案和效果仍存在争议。本研究旨在评估淋巴细胞主动免疫疗法（LAI）免疫治疗对URSA患者的效果，并为该治疗的临床效果提供依据。
收集并分析619例URSA患者的详细数据，其中465例患者接受免疫治疗（LAI组），154例患者未接受免疫治疗（对照组）。
LAI组所有患者中有77.6%接受免疫治疗后，母体封闭抗体（BA）由阴性转为阳性。母体BA转化率随主动免疫次数增加而升高（>4次，P<0.05）。LAI组妊娠率高于对照组（P<0.05），活产率和流产率有显著差异（P<0.05）。此外，与自然妊娠相比，主动免疫后的体外受精（IVF）患者活产率较高，流产率较低，尽管差异不显著（P>0.05）。
淋巴细胞免疫治疗后，大多数不明原因复发性自然流产患者的BA由阴性转为阳性。无论BA是否转化，免疫治疗后妊娠率和活产率均升高，流产率降低。因此，主动免疫疗法可改善不明原因复发性流产患者的妊娠结局。
