主动免疫治疗不明原因习惯性流产33例疗效分析

Clinical Study of Active Immunotherapy in the Treatment of Thirty-three Unexplained Habitual Abortions

目的观察主动免疫治疗不明原因习惯性流产的疗效。方法对33例不明原因习惯性流产患者采取主动免疫治疗,观察治疗效果,比较治疗前后外周血免疫相关指标变化以及该变化与疗效的相关性。结果 (1)共妊娠23例(69.7%),其中已足月分娩10例(30.3%),早产3例(9%),目前尚在妊娠中8例(24.2%),再次自然流产2例(6%);未受孕10例(30.3%)。(2)治疗后免疫球蛋白IgG、IgM水平较治疗前明显下降(P<0.05),补体C3、CD4亦有下降趋势(均P<0.05)。(3)在治疗成功组,IgG、IgM、C3、CD4/CD8水平于治疗后明显下降(均P<0.05),而治疗失败、不孕组治疗前后各指标变化差异无统计学意义(P>0.05)。(4)对免疫治疗结局有影响的指标为IgM、C4、CD3、CD8、ACA阳性和流产次数;治疗前C4越高、CD8越低、流产次数越多以及ACA阳性者,越容易导致治疗失败。结论主动免疫治疗是治疗不明原因性习惯性流产的有效方法 ;治疗后免疫球蛋白、补体以及T淋巴细胞亚群比例均朝有利于妊娠的方向发展;治疗前的有关指标可以预示治疗结局,有利于指导临床治疗选择。

Objective To explore the effect of active immunotherapy on unexplained habitual abortion（UHA）.Methods Thirty-three cases of UHA were taken into the study,the levels of related immune index berore and after active immunotherapy,and investigated the associativity was investigated between the index and therapy effect.Results （1） Among the 33 cases,23 cases were conceived（67.7%）,and 10 cases delivered full-termly（30.3%）,3 cases premature delivered（9%）,8 cases were still in the process of pregnancy（24.2%）,and 2 cases underwent spontaneous abortion once again（6%）,10 cases were infertile（30.3%）.（2） Immunoglobulin IgG、IgM and alexine C3 and CD4 cells decreased significantly after active immunotherapy（P0.05）.（3） After the therapy,the levels of the IgG、IgM、C3、CD4/CD8 in the group with successful results were significantly decreased（P0.05）,but there are no obviously change in the Treatment Failure、infertile group.（4） IgM,C4,CD3,CD8,ACA and the abortion frequency were correlated with the outcome of active immunotherapy.The levels of C4、the abortion frequency and ACA（＋） were negatively correlated with the effect of active immunotherapy,while the levels of CD8 were positive correlation.Conclusion Active immunotherapy is an effective treatment for the UHA,it can improve the levels of Immunoglobulin、alexine and T lymphocytes sub-types,in favor of conception.Some related idex can prognosticate the outcome of therapy,in favor of clinic.