免疫治疗前后不明原因习惯性流产患者ACA、封闭抗体表达的变化

Expression changes of ACA and APLA in patients with URSA before and after immunotherapy

目的 探讨健康妊娠妇女与不明原因习惯性流产妇女（unexplained recurrent spontaneous abortion;URSA）免疫治疗前后ACA（抗心磷脂抗体）、APLA（封闭抗体）表达差异,评价ACA、APLA在指导再次妊娠中的作用.方法 采用酶联免疫试验分别测定健康对照组和不明原因习惯性流产患者治疗前后ACA、APLA的变化.结果 免疫治疗后165例不明原因习惯性流产患者有126例再次妊娠,其中妊娠超过6个月的有112例,14例再次发生早期流产不明原因习惯性流产患者治疗前ACA、APLA阳性百分率分别是30.5%（51/165）、9.2%,健康对照妇女ACA、APLA百分率为4.0%、28.0%,健康对照组ACA阳性百分数低于不明原因习惯性流产患者,APLA高于不明原因习惯性流产患者,两组ACA、APLA表达有显著性差异.免疫治疗后不明原因习惯性流产患者封闭抗体阳性百分率为78.3%,与治疗前相比,免疫治疗可增加APLA的表达.免疫治疗后ACA阳性率为26.1%.与治疗前相比ACA没有明显变化.结论 淋巴细胞主动免疫治疗能提高不明原因习惯性流产患者再次妊娠的成功率,APLA对指导习惯性流产患者妊娠及对再次妊娠的结局有良好的参考价值,但ACA不能作为一个独立的指标评价或指导再次妊娠.

Objective To investigate the expression changes of ACA and APLA in patients with unexplained recurrent spontaneous abortion and evaluate their contribution in the next pregnancy. Methods Concentrations of ACA, APLA were measured by enzyme - linked immune sor- bant assay （ELISA） method in sera from heaths control and unexplained RSA women before and after immunotherapy. Results Among the 165 URSA Patients, 126 patients get Pregnancy after finishing the whole immunotherapy （11.43 % ）, 112 patients experienced 6 - months pregnan- cy, and 14 patients encounter abortion during the Early trimester. Positive rate of ACA and APLA in patients with URSA were 30.5 % and 9. 2% respectively, and those of healths control were 4.0% and 28.0% respectively. Compared with health control, positive rate of APLA is much lower and positive rate of ACA is much higher. There were significant difference in the two groups. After immunotherapy positive rate of ACA and APLA were 78.3 % and 26.1%. After immanotherapy the positive rate of APLA was significantly increased, but the positive rate of ACA showed no significant difference befroe and after immunotherapy. Conclusion The active immunotherapy by intradcrmally injention of paternal lyphocyte is an effective therapy to URSA Patients. APLA was a useful reference indieafion for next preganey. However ACA can＇ t be used as a independently reference indication for next preguncy.