免疫-凝血相关性复发性流产治疗进展

Treatment of the Recurrent Spontaneous Abortion Caused by Dysimmunity and Prethrombotic State

复发性流产病因复杂,目前血栓前状态和免疫因素受到越来越多的关注。当进行一系列针对性的筛查试验确定妊娠妇女处于免疫异常或血栓前状态时,如何进行治疗是亟待解决的问题。一般情况下,当淋巴细胞功能异常和自身抗体、补体系统异常时可以用泼尼松、环孢素、免疫球蛋白及脂肪乳;当狼疮抗体筛查试验异常,抗SSA、抗SSB、抗ds DNA异常时可以使用泼尼松、羟氯喹及免疫球蛋白;当封闭抗体阴性时一般使用环孢素和免疫球蛋白;当凝血指标异常、抗磷脂抗体阳性时可以用阿司匹林和低分子肝素。目前这些药物的应用不在说明书适用范围,属于超说明书应用。但是国内外大量临床试验证明有复发性流产史的育龄期女性可以从这些药物中获益。为了分析这些药物在免疫-凝血相关性复发性流产治疗方面的利弊,参考国内外文献,对这些药物的作用机制及临床效果进行综述。

Many etiologies attribute to the recurrent spontaneous abortion(RSA).Nowadays,the prethrombotic state and immunological factors have aroused more and more attention.However,it is difficult for us to treat the RSA related to dysimmunity or prethrombotic state.Usually,prednison,ciclosporin,immune globulin and lipid emulsion can be used in those women with abnormal lymphocyte,autoantibody and abnormal complement system.Prednison,hydroxychioroquine and immune globulin are used in those woman with the positive lupus screening test,and abnormal anti-SSA,anti-SSB and anti-dsDNA.Ciclosporin and immune globulin can be used when the blocking antibody is negative,while aspirin and low molecular heparin used when the coagulation indicator is abnormal and the antiphospholipid antibody is positive.Most of these drugs are out of their scopes when they are used in RSA.However,a great deal of clinical trials have proved that RSA women can authentically benefit from these drugs.We discussed the advantages and disadvantages of these drugs when used in RSA women,including the mechanism and clinical effects.