评价父系淋巴细胞免疫治疗和潜在的生物标志物混合淋巴细胞反应阻断因子在阿根廷队列的不明原因复发性自然流产和不明原因不孕的妇女。
Evaluation of paternal lymphocyte immunotherapy and potential biomarker mixed lymphocyte reaction-blocking factor in an Argentinian cohort of women with unexplained recurrent spontaneous abortion and unexplained infertility.
机构信息
Immunogenetics Laboratory, INIGEM, CONICET-UBA, Hospital de Clínicas, University of Buenos Aires, Argentina.
Department of Microbiology, Parasitology and Immunology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
出版信息
Am J Reprod Immunol. 2021 Aug;86(2):e13422. doi: 10.1111/aji.13422. Epub 2021 Jun 3.
PROBLEM
Analyze the effect of paternal immunotherapy treatment (PIT) in primary and secondary unexplained recurrent spontaneous abortion (URSA) and unexplained infertility (UI).
METHODS OF STUDY
A retrospective study analyzed a two-year follow-up between the generation of MLR-Bfs after PIT treatment (or controls first consultation) and a live birth. Recruited patients included primary URSA with two or more miscarriages at <12 weeks gestation, secondary URSA with previous live birth before two or more miscarriages, and UI with inability to conceive after 2 years of regular unprotected intercourse or in vitro fertilizations (IVF). PIT treated were compared with untreated controls.
RESULTS
Primary URSA: live birth was 241/416 (58%) versus 64/282 (23%) controls (p < .0001). Up to age 35, success was 158/217 (73%) and 37/144 (26%) controls (p < .0001). With 3 or more previous URSA, success was 90/135 (67%) versus 17/79 (22%) controls (p < .0001). Between ages 36 and 40, success was 69/147(47%) versus 22/98 (22%) controls (p < .0003), with 3 or more previous URSA live birth was 45/95 (47%) versus 6/46 (13%) controls (p < .0001). In UI, live birth was 99/298 (33%) versus 54/263 (21%) in controls (p < .0009) that increased under age 35 to 53/116 (46%) in treated versus 26/101 (26%) controls (p < .0056). In PIT treated, IVF success required a median of 1 (1.37 ± 0.67) versus a median of 3 IVF procedures (2.75 ± 0.84) in controls.
CONCLUSION
PIT is a successful treatment for primary and secondary URSA, and UI. PIT reduced the number of IVF required for achieving pregnancy.
问题
分析父系免疫疗法治疗（PIT）对原发性和继发性不明原因复发性自然流产（URSA）和不明原因不孕（UI）的影响。
方法
本研究为回顾性研究，对 PIT 治疗后（或对照组首次就诊）MLR-Bfs 产生后的两年内进行随访，以活产为终点。入组患者包括原发性 URSA，妊娠 12 周前发生两次或更多次流产；继发性 URSA，既往有两次或更多次流产前的活产；UI，2 年规律未避孕性生活或体外受精（IVF）后仍无法受孕。将 PIT 治疗组与未治疗对照组进行比较。
结果
原发性 URSA：活产率为 241/416（58%）vs 64/282（23%）对照组（p<0.0001）。在 35 岁以下，成功率为 158/217（73%）vs 37/144（26%）对照组（p<0.0001）。对于 3 次或更多次原发性 URSA，成功率为 90/135（67%）vs 17/79（22%）对照组（p<0.0001）。36-40 岁时，成功率为 69/147（47%）vs 22/98（22%）对照组（p<0.0003），对于 3 次或更多次原发性 URSA，活产率为 45/95（47%）vs 6/46（13%）对照组（p<0.0001）。在 UI 中，活产率为 99/298（33%）vs 54/263（21%）对照组（p<0.0009），在 35 岁以下时，治疗组的活产率为 53/116（46%）vs 对照组的 26/101（26%）（p<0.0056）。在 PIT 治疗组中，IVF 成功所需的中位数为 1（1.37±0.67）次，而对照组为中位数 3 次（2.75±0.84）。
结论
PIT 是治疗原发性和继发性 URSA 和 UI 的有效方法。PIT 降低了实现妊娠所需的 IVF 次数。
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