人类白细胞抗原分型在淋巴细胞主动免疫治疗不明原因复发性流产中的价值研究

Clinical efficacy study of human leukocyte antigen typing in women of unexplained recurrent spontaneous abortion with lymphocyte immunotherapy

目的探讨人类白细胞抗原(HLA)-DR/DQ分型在免疫治疗不明原因复发性流产(URSA)中的价值。方法选择2013年5月至2015年3月在华中科技大学同济医学院附属同济医院确诊为URSA、封闭抗体(BA)为阴性的患者243例,根据患者治疗前是否检测自身及供血者的HLA-DR/DQ分型,分为观察组130例(HLA相容位点≤1个为A组107例,相容位点有2个为B组23例)和对照组113例(治疗前未检测患者及供血者的HLA-DR/DQ分型)。比较各组治疗后的BA阳性率及成功妊娠率,用多因素非条件Logistic回归进行相关因素分析。结果 A组BA阳性率及成功妊娠率分别高于对照组及B组,对照组BA阳性率及成功妊娠率高于B组(均P<0.05)。在A组中选择与患者有0或1个HLA相容位点的供血者,患者治疗后,成功妊娠率差异无统计学意义(P>0.05)。患者年龄<35岁时,观察组成功妊娠率明显高于对照组(P<0.05)。选择配偶或第三方供血,患者治疗后,成功妊娠率差异无统计学意义(P>0.05)。Logistic回归分析显示年龄是主动免疫治疗后BA阳性及成功妊娠的独立影响因素。结论 HLA-DR/DQ分型可提高URSA患者免疫治疗后BA阳性率及成功妊娠率。

Objective Objective To investigate the role of human leukocyte antigen （HLA-DR/DQ） typing in women of URSA with lymphocyte immunotherapy. Methods We chose 243 patients that were diagnosed as URSA in Wuhan Tongji Hospital from May 2013 to March 2015 with negative blocking antibodies （BA）.They were randomly assigned to two groups according to whether the patients and their blood donors were detected HLA-DR/DQ type before therapy, the observed group A was for less than one compatible site,and observed group B was for two compatible site.Compared the positive rate of BA and the successful pregnancy rate of two groups after therapy,and the Logistic regression was used for the analysis of related factors.Results The positive rate of BA and successful pregnancy rate in the observed group A was significantly higher than control group and observed group B, and the positive rate of BA and successful pregnancy rate in control group was significantly higher than observed group B,all the differences were statistically significant （P 〈 0.05）.The difference was not statistically significant after therapy when there was 0 or 1 HLA compatible site between the patients and their blood donors in observed group A （P 〉 0.05 ） .The rate of successful pregnancy rate in all of the ob- servational group was significantly higher than the control group when the patients were younger than 35 years old and the difference was statistically significant （P 〈 0.05）.The difference was not statistically significant after treatment when the blood donor was their spouses or the third people （P 〉 0.05 ）.The Logistic regression analysis showed that age was an independent influencing factor of the positive rate of BA and successful pregnancy after lymphocyte immunotherapy. Con- clusion The positive rate of BA and the successful pregnancy rate of URSA patients with HLA-DR/DQ were improvedby HLA-DR/DQ typing before Lymphocyte immunothera- py.