Braun Anne-Sophie, Vomstein Kilian, Reiser Elisabeth, Tollinger Susanne, Kyvelidou Christiana, Feil Katharina, Toth Bettina
Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
Department of Obstetrics and Gynecology, The Fertility Clinic, Copenhagen University Hospital, Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark.
J Clin Med. 2023 Aug 27;12(17):5585. doi: 10.3390/jcm12175585.
RPL and RIF are challenges in reproductive medicine. The immune system plays a pivotal role in endometrial receptivity, successful implantation, and pregnancy complications. Immunological changes have been associated with RPL and RIF. Understanding immune dysregulation especially in NK and T cell subtypes may lead to better diagnostic concepts and treatments. From July 2019 to August 2020 patients with RPL and RIF underwent a standardized diagnostic procedure including endometrial biopsies. Immune cell analysis was performed using flow cytometry. Patients were contacted in March 2023 and interviewed concerning their pregnancy outcomes following diagnostics.
Out of 68 patients undergoing endometrial biopsies, 49 patients were finally included. Live birth rates were high with 72% in RPL and 86% in RIF. Immune cell analysis revealed that patients with RPL had more cytotoxic CD56CD16 cells, while RIF patients had more CD56 uNK cells. RPL patients with pregnancy complications showed increased NKT cell percentages.
Our findings suggest specific immune changes in RPL and RIF patients, offering potential therapeutic targets. Tailored immunotherapy based on endometrial immunophenotyping might be an option, but further research is needed.
复发性流产（RPL）和反复种植失败（RIF）是生殖医学中的难题。免疫系统在子宫内膜容受性、成功着床及妊娠并发症中起关键作用。免疫变化与RPL和RIF相关。了解免疫失调，尤其是自然杀伤细胞（NK）和T细胞亚群的失调，可能会带来更好的诊断理念和治疗方法。2019年7月至2020年8月，RPL和RIF患者接受了包括子宫内膜活检在内的标准化诊断程序。使用流式细胞术进行免疫细胞分析。2023年3月与患者取得联系，并就诊断后的妊娠结局进行了访谈。
在68例行子宫内膜活检的患者中，最终纳入49例。活产率较高，RPL患者为72%，RIF患者为86%。免疫细胞分析显示，RPL患者具有更多的细胞毒性CD56CD16细胞，而RIF患者具有更多的CD56未成熟NK细胞。有妊娠并发症的RPL患者自然杀伤T细胞（NKT）百分比增加。
我们的研究结果提示RPL和RIF患者存在特定的免疫变化，提供了潜在的治疗靶点。基于子宫内膜免疫表型分析的个体化免疫治疗可能是一种选择，但仍需进一步研究。
