Mohapeloa H, Christiansen O B, Grunnet N
Department of Obstetrics and Gynaecology, Aalborg Hospital, Denmark.
Hum Reprod. 1998 Apr;13(4):1079-82. doi: 10.1093/humrep/13.4.1079.
The release of certain cytokines, e.g. tumour necrosis factor (TNF)-alpha, in the amniotic fluid has been suggested to be a cause of preterm birth. The predisposition to excessive liberation of cytokines from peripheral leukocytes has been shown to depend partly on the individual's HLA-DR genotype. The HLA-DR1 and -DR3 alleles have previously been reported as being associated with a TNF-alpha high responder status and have also been associated with unexplained recurrent spontaneous abortions. In the present study, HLA-DR typing was performed in 10 women who had experienced recurrent very early preterm births resulting in perinatal death, or late spontaneous abortions under a clinical picture resembling that traditionally attributed to cervical incompetence. All patients had had at least one mid-trimester miscarriage in spite of the insertion of a cervical cerclage. Nine out of 10 (90%) patients had the HLA-DR phenotypes DR1 and/or DR3 compared with 37% in the background population (P < 0.005). The results suggest that HLA-DR-associated immunological factors might play a part in recurrent late spontaneous abortions and extremely preterm births under a cervical incompetence-like picture, at least in the subset of cases not treatable by cervical cerclage.
羊水内某些细胞因子的释放，例如肿瘤坏死因子（TNF）-α，被认为是早产的一个原因。已表明外周血白细胞过度释放细胞因子的易感性部分取决于个体的HLA-DR基因型。HLA-DR1和-DR3等位基因先前已有报道与TNF-α高反应状态相关，并且也与不明原因的复发性自然流产有关。在本研究中，对10名有复发性极早期早产导致围产期死亡或晚期自然流产的妇女进行了HLA-DR分型，这些妇女的临床表现类似于传统上归因于宫颈机能不全的情况。尽管放置了宫颈环扎术，但所有患者至少有一次孕中期流产。10名患者中有9名（90%）具有HLA-DR表型DR1和/或DR3，而在背景人群中这一比例为37%（P<0.005）。结果表明，HLA-DR相关的免疫因素可能在类似宫颈机能不全情况下的复发性晚期自然流产和极早产中起作用，至少在不能通过宫颈环扎术治疗的病例亚组中如此。
