抗滋养细胞膜、抗子宫内膜及抗HCG抗体与IVF-ET结局关系

THE CORRELATION OF ANTITROPHOBLAST ANTIBODY,EMAB AND HCG-AB WITH IVF-ET PREGNANCY OUTCOME

目的探讨抗滋养细胞膜抗体（ATA）、抗子宫内膜抗体（EmAb）、抗HCG抗体对体外受精-胚胎移植（IVF-ET）妊娠结局的影响。方法选择2002年1月~2007年7月在本生殖医学中心由于不明原因性不育、女方输卵管因素和（或）男方轻度少弱精子症因素不育而接受IVF-ET治疗的妇女140例,其中多次种植失败31例,生化妊娠丢失26例及临床妊娠丢失18例,持续妊娠65例（对照组）。比较各组和对照组妇女各种不育因素所占比例,同时比较各组妇女血清ATA、EmAb和抗HCG抗体阳性率。结果多次种植失败组、生化妊娠丢失组及临床妊娠丢失组不明原因性不育明显高于对照组（χ2=8.2~14.6,P〈0.01）;多次种植失败组、生化妊娠丢失组及临床妊娠丢失组ATA阳性率显著高于对照组（χ2=6.8~11.8,P〈0.01）;生化妊娠丢失组和临床妊娠丢失组抗HCG抗体高于对照组（χ2=4.4、5.3,P〈0.05）;多次种植失败组妇女血清EmAb阳性率明显高于其他组（χ2=5.5,P〈0.05）。结论免疫性因素是不明原因性不孕的重要原因;过度表达的ATA可干扰整个妊娠过程,抗HCG抗体的存在能增加IVF-ET临床妊娠流产率和生化妊娠流产率;EmAb可干扰胚胎种植,导致IVF-ET反复种植失败。

Objective To assess the effect of antitrophoblast antibody, EmAb and HCG-Ab on in vitro fertilization and embryo transfer （IVF-ET） outcome. Methods This study included 140 infertility women of unexplained reasons, salpingem phraxis and/or male factor undergoing IVF ET, of whom, 31 with repeated failure of implantation; 26 with biochemical loss of pregnancy; 18 with clinical pregnancy loss. Sixty-five with clinical pregnancy served as control group. The ratio of different reasons of infertility and the rate of antitrophoblast antibody （ATA）, EmAb and HCG-Ab in different groups were compared. Results The rate of immune infertility was higher in repeated implantation failure group, biochemical pregnancy group, and clinical pregnancy loss group than in control group （X^2= 8.2-14.6, P〈 0.01 ）, the ATA positive rate in those three groups was also higher than that of the control group （X^2= 6.8-11.8, P〈0.01）. The serum EmAb in the repeated implantation group was higher than the other groups （X^2 =5.5,P〈0. 05）. Conclusion Immune factor is an important cause of unexplained infertility; overexpress of ATA may interfere the whole course of pregnancy. EmAb can interfere embryo implanting and HCG-Ab is one of the reasons of decreasing IVFET pregnancy.