王海燕复发性流产2012.pptVIP

* * * * * * * * Pregnancy is a semi-graft – 50% of the fetal antigens are foreign to the mother. In some pregnancies, the mother recognizes these foreign paternal antigens and sets up an immune rejection reaction to them, which causes abortion. In habitual abortion, this reaction is repeated in every subsequent pregnancy. In healthy pregnancy, however, the fetus is not compromised by an allogenic immune response. In these pregnancies, a cross talk between the pre-embryo and the mother-to-be starts early after fertilization, and results in a protective immune response in the mother. * 母亲对胎儿的排斥有许多不同的途径，但有三条途径尤其重要，即： 抗体介导 T 辅助 (Th1) 细胞介导 自然杀伤 (NK) 细胞介导 * 在了解了致流产转变后，就容易理解利于胚胎保护的机制，即与胚胎排斥相反 的机制。 胚胎保护免疫调节有以下三条途径： 不对称抗体：不能与抗原完美结合，仅封闭抗原结构，不激活实体级联反应，无细胞毒及细胞吞噬作用。 保护性或 Th2反应占优势导致保护性细胞因子的激活，抑制有害的Th1 反应。 无 TNF? 和白介素 2释放，因此NK细胞激活减少， NK 细胞不能转变成对 胚胎有毒性的LAK 细胞。 这些因素最终形成保护性免。 * * The first pathway in abortion or embryo destruction due to immunologic interaction is mediated through symmetric antibodies. An antibody is like a ‘Y’, made up of 2 Fab parts and 1 Fc part. The Fab parts, which form the double arms of the ‘Y’, bind with the fetal antigen. Thereafter, the Fc part which forms the single arm of the ‘Y’ binds with the complement component C1q leading to activation of the complement cascade. This results in cytotoxic and phagocytic reactions, eventually causing destruction of the fetus. As mentioned by Prof. Szekeres-Bartho, normally the amount of IgG is 10%. However, in pregnancy, the amount of IgG increases to 40% with 90% being found in the placenta. Interestingly, asymmetric antibodies, which do not express the `Y`-like shape, have been suggested to be pregnancy-protective by masking fetal antigens without being embryo toxic. PIBF leads to a mannose residue on one of the Fab arms of the antibody making the antibody asymmetrical 因免疫交互作用而导致流产或胚胎毁损的第一个途径就是对称性抗体介导途径。 抗体像个‘Y’，有2个Fab片段（抗原结合片段）和1个Fc片段（结晶片段）组成。Fab片段形成‘Y’的双臂用来结合胎儿抗原，Fc片段形成‘Y’的单臂以结合补体C1q而产生补体级联激活作用。这导致细胞毒性和吞