郁琦2009反复流产治疗进展.pptVIP

孕妇 剂量 早孕期流产率 活产率 泼尼松 黄体酮 阿司匹林 叶酸 50 20 mg/日 20 mg/日 100 mg/日 5 mg 隔日一次 19% 77% 对照组 52 63% 35% 联合治疗（标准治疗、鸡尾酒疗法） (P = 0.04) Tempfer, CB. Fertil Steril 2006 不明原因RPL治疗 阿司匹林75～100mg/日 泼尼松2.5mg～10mg/日 叶酸1mg/日或复合维生素微量元素1＃/日 三个月后试妊娠 BBT升高5日后地屈孕酮10mg每日2次 上述药物应用至孕3个月 Summary RPL需要全面检查原因，绒毛染色体十分重要 治疗需针对病因个体化进行 孕激素为免疫耐受的基础 抗磷脂综合征患者的抗凝治疗受到多数文献的肯定 免疫抑制剂和免疫治疗可能只针对某些特定人群有效，但目前缺乏必要的准确检查手段 在更准确，更有针对性的检查方法问世之前，联合治疗可能是一种选择 * * 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