Department of Immunology, IVI RMA Madrid, Spain; Rey Juan Carlos University, Madrid, Spain.
IVI RMA New Jersey, Basking Ridge, New Jersey.
Fertil Steril. 2021 Mar;115(3):561-566. doi: 10.1016/j.fertnstert.2021.01.017. Epub 2021 Feb 17.
Certain miscarriages result from immunologic factors, but there is no clear identification of the precise causes of recurrent pregnancy loss (RPL). Miscarriages and RPL can arise from a disruption of maternal-fetal immune homeostasis. Remodeling of the maternal uterine spiral arteries is one of the key steps for normal growth and development of the fetus. An adequate oxygen supply is necessary for correct placentation, and it is accomplished by proper vascular changes. The development of fetal tissues creates a potential immunologic problem since the fetus can express paternal antigens and, in some cases, antigens of a gamete donor. The maternal immune system actively responds to fetal antigens, and dysregulation of this crosstalk could partly explain pregnancy complications such as miscarriages and RPL. RPL resulting from thrombophilia is primarily due to acquired thrombophilia, and therefore screening and treatment should be focused on antiphospholipid antibody syndrome.
某些流产是由免疫因素引起的，但反复妊娠丢失（RPL）的确切原因尚不清楚。流产和 RPL 可能源于母体-胎儿免疫稳态的破坏。母体子宫螺旋动脉的重塑是胎儿正常生长和发育的关键步骤之一。充足的氧气供应对于正确的胎盘形成是必要的，这是通过适当的血管变化来实现的。胎儿组织的发育会产生潜在的免疫问题，因为胎儿可以表达父系抗原，在某些情况下，还可以表达配子供体的抗原。母体免疫系统会主动对胎儿抗原做出反应，这种相互作用的失调可能部分解释了流产和 RPL 等妊娠并发症。由血栓形成倾向引起的 RPL 主要是由于获得性血栓形成倾向，因此筛查和治疗应集中在抗磷脂抗体综合征上。
