卵巢早衰的免疫学病因及免疫干预研究进展

Research advances on the immunological pathogenesis and immunotherapy of premature ovarian failure

卵巢早衰(POF)是指女性40岁之前出现卵巢功能衰退,是一种临床高度异质、病因混杂的妇科内分泌疾病,是导致女性不孕不育的重要原因之一。POF病因复杂,涉及染色体异常、基因突变、自身免疫异常、医源性损伤、代谢异常及感染等多种因素,但大多数患者发病原因尚不明确。自身免疫异常在POF中占10%~30%,主要表现为存在抗卵巢自身抗体和免疫细胞介导的免疫性卵巢炎、伴发自身免疫性相关疾病,但目前自身免疫失调诱导卵泡耗竭的具体机制仍不明确,临床缺乏有效的免疫监测或诊断指标,相关免疫干预手段仍需循证医学以及高质量临床研究的证实。

Premature ovarian failure（POF） is characterized by cessation of ovarian function in women younger than 40 years. It presents highly heterogeneous clinical phenotype and etiology, and greatly jeopardizes the fertility of patients.Variable causes and pathogeneses have been identified, including chromosome abnormalities, genetic mutations, auto- immune dysfunctions, and iatrogenic, metabolic or infectious factors, whereas a large proportion of causes still remain unknown. Autoimmune dysfunctions are involved in the pathogenesis of 10%-30% of POF cases, evidenced by autoim- mune oophoritis complicated with other autoimmune disorders. However, the contribution of autoimmune deregulation to the pathogenesis of ovarian follicles depletion and dysfunction remains elusive. Reliable diagnostic or predictive biomark- ers for ovarian autoimmunity are still unavailable at present. The efficacy of immunological interventions needs evidence- based medicine and high quality clinical trials to confirm.