Sorbonne Université Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France.
Sorbonne Université, Paris, France.
Am J Reprod Immunol. 2021 Aug;86(2):e13425. doi: 10.1111/aji.13425. Epub 2021 Apr 12.
Recurrent miscarriages are defined as three or more early miscarriages before 12 weeks of gestation. The aim of this study was to describe a cohort of women with unexplained recurrent miscarriages, evaluate several potential biomarkers of immune origin, and describe the outcome of pregnancies under immunomodulatory therapies.
Women having a history of at least 3 early miscarriages without any etiology were recruited from 3 university hospitals.
Among 101 women with recurrent miscarriages, overall, 652 pregnancies have been included in the analysis. Women which experienced miscarriages were older (33.3 ± 5.4 versus 31.9 ± 6.7; p = 0.03), with history of more pregnancies (4 (2-6) versus 3.5 (1-5.75); p 0.0008), and less frequently the same partner (406 (74%) versus 79 (86%); p=0.01). There was no difference in the level and frequencies of biomarkers of immune origin (NK, lymphocyte, gamma globulins and blood cytokine levels and endometrial uNK activation status), except the higher rates of positive antinuclear antibodies in women with live birth (12 (13%) versus 36 (7%); p=0.03). Among the 652 pregnancies, 215 (33%) have been treated and received either aspirin/low weighted molecular heparin (LMWH) and/or combined to different lines of immunomodulatory treatment. Patients with pregnancy under treatment had a significantly higher rate of cumulative live birth rate than those with untreated ones (43.0% vs 34.8%; p = 0.04). When compared to patients with untreated pregnancies, patients with steroids during the pregnancy had twice more chances to obtain live birth (OR 2.0, CI95% 1.1 - 3.7, p = 0.02).
Unexplained recurrent miscarriages could have improved obstetrical outcome under immunomodulatory therapies and in particular steroids.
复发性流产定义为 12 周前发生的 3 次或更多次早期流产。本研究旨在描述一组不明原因复发性流产的患者，评估几种潜在的免疫源性生物标志物，并描述免疫调节治疗下妊娠的结局。
从 3 所大学医院招募至少有 3 次早期流产史且无任何病因的女性。
在 101 名复发性流产的女性中，共有 652 次妊娠纳入分析。经历过流产的女性年龄更大（33.3 ± 5.4 岁 vs. 31.9 ± 6.7 岁；p = 0.03），妊娠次数更多（4（2-6）次 vs. 3.5（1-5.75）次；p 0.0008），且伴侣相同的频率较低（406（74%） vs. 79（86%）；p=0.01）。免疫源性生物标志物（NK 细胞、淋巴细胞、γ球蛋白和血液细胞因子水平以及子宫内膜 uNK 激活状态）的水平和频率没有差异，除了活产女性的抗核抗体阳性率更高（12（13%） vs. 36（7%）；p=0.03）。在 652 次妊娠中，有 215 次（33%）接受了治疗，并接受了阿司匹林/低分子量肝素（LMWH）和/或不同免疫调节治疗的联合治疗。接受治疗的妊娠患者的累积活产率显著高于未治疗的妊娠患者（43.0% vs. 34.8%；p = 0.04）。与未接受治疗的妊娠患者相比，妊娠期间接受类固醇治疗的患者获得活产的几率增加了两倍（OR 2.0，95%CI 1.1-3.7，p = 0.02）。
不明原因的复发性流产可以通过免疫调节治疗，特别是类固醇治疗来改善产科结局。
