Vinatier D, Monnier J C
Maternité du Pavillon Victor-Olivier, Service de Gynécologie-Obstétrique, CHRU de Lille.
J Gynecol Obstet Biol Reprod (Paris). 1993;22(7):709-21.
In the last decade works on the responses of the mother's immune system to the presence of the feto-placental unit have burgeoned. The antigens that are presented to the mother are special because the trophoblast does not show classical transplantation antigens which are classically implicated in graft rejection. A class I antigen, antigen HLA-G is present in the extra-villous cytotrophoblast, different from classical antigens by virtue of its molecular weight and its reduced antigenic polymorphism. Many functions have been attributed to this antigen; most of them are still being evaluated. The most important immunological phenomena are found at the feto-placental interface. Several events occur simultaneously or successively. Recognition of the trophoblast brings about an inflammatory reaction which is the initial phase of graft rejection. The numerous cytokines that are produced in this initial phase allow decidualization to occur and for the embryo to implant when it has reached an adequate stage of evolution. Rapidly, immunosuppressant mechanisms stop this rejection reaction which if not stopped can cause the pregnancy to end. There is a delicate equilibrium between the different cytokines, those favourable to pregnancy and those damaging to pregnancy. The trophoblast which is resistant to factors which would cause rejection protects the fetus particularly if its growth is helped along by certain cytokines. On the other hand, other cytokines are prejudicial to the growth of the trophoblast and activate certain cytotoxic cells which become aggressive. The maternal immune system and the endocrine system work together to maintain this cytokine network which if destabilized leads to certain pathological situations. Disturbances can be due to poor maternal recognition particularly if the trophoblast does not give out good antigens, or if the mother is genetically programmed not to respond although the disturbance can come from external factors such as certain infections.
在过去十年中，关于母亲免疫系统对胎儿 - 胎盘单位存在的反应的研究迅速发展。呈现给母亲的抗原很特殊，因为滋养层不显示经典的移植抗原，而这些抗原通常与移植排斥有关。一种I类抗原，即HLA - G抗原存在于绒毛外细胞滋养层中，因其分子量和降低的抗原多态性而不同于经典抗原。这种抗原具有多种功能；其中大多数仍在评估中。最重要的免疫现象发生在胎儿 - 胎盘界面。几个事件同时或相继发生。对滋养层的识别引发炎症反应，这是移植排斥的初始阶段。在这个初始阶段产生的众多细胞因子使蜕膜化发生，并使胚胎在达到适当发育阶段时着床。很快，免疫抑制机制阻止了这种排斥反应，如果不阻止，这种反应可能导致妊娠终止。在有利于妊娠和损害妊娠的不同细胞因子之间存在微妙的平衡。对导致排斥的因素具有抗性的滋养层保护胎儿，特别是如果其生长受到某些细胞因子的促进。另一方面，其他细胞因子对滋养层的生长有害，并激活某些具有攻击性的细胞毒性细胞。母体免疫系统和内分泌系统共同作用以维持这个细胞因子网络，如果该网络不稳定则会导致某些病理情况。干扰可能是由于母体识别不良，特别是如果滋养层不能释放良好的抗原，或者如果母亲的基因编程使其不产生反应，尽管干扰也可能来自外部因素，如某些感染。
