反复流产治疗进展.ppt

* In about 50% of habitual abortion cases, the causes are explainable. A large majority of these are due to genetic defects. Other known causes include anatomical abnormalities such as a bicornuate uterus or large submucosal myomas; endocrine disorders such as uncontrolled diabetes mellitus; infectious diseases in the mother and/or fetus, and auto-immune diseases such as the presence of Anticardiolipin antibodies in the mother or the antiphospholipid syndrome. All these disorders can cause abnormalities in the fetus which are incompatible with life, and consequently the fetus is aborted. But in the other 50% of cases, the cause of habitual abortion remains a mystery. However, there is now growing evidence that a substantial number of these “unexplained” pregnancy losses may be the result of an allogenic immune response by the mother towards the paternal antigens present in the fetus such as deficient immunosupression or maternal immuno-reactivity. Imagine a situation where a husband donates a kidney to his wife, a kidney transplantation or graft. If no compatibility testing was performed, a severe immune reaction to the foreign kidney may well occur within days. This immune reaction may be severe enough to cause death. A similar kind of reaction takes place in some women towards their fetus, which gets half its chromosomes from the father and therefore inherits half his antigens. 约50％的习惯性流产患者的病因是可以解释的。大多数系遗传缺陷所致，其它已知病因包括解剖异常如双角子宫或大的粘膜下肌瘤；内分泌紊乱如未控制的糖尿病，母亲和/或胎儿的感染性疾病，以及自身免疫性疾病如母亲体内出现抗心磷脂抗体或抗磷脂综合征。所有这些紊乱均可能引起致死性胎儿异常，并导致胎儿流产。 但在另外50％病例中，习惯性流产的原因仍不清楚。 更多的证据显示，大量 “原因不明”的妊娠失败，是母亲对胎儿体内的父系抗原产生同种异体的免疫反应的结果，如免疫抑制缺陷或母体免疫应答不足。 假设丈夫捐给妻子一个肾脏作肾移植术，如果未作配对检验的话，那么在移植术后几天内妻子体内就会对异体肾脏做出强烈的甚至致死性的免疫反应。同样在一些女性体内也会对其胎儿出现类似的反应，这是由于胎儿的染色体一半来自父亲，因此胎儿带有一半父系抗原。 * The P-receptors on the pregnancy lymphocytes, CD56+ cells and PBMC, are not regulated by steroids but are rather up-regulated by immune mechanisms. After trophoblastic invasion into the endometrium, the pregnancy lymphocytes are act