复发性流产影响生命全程保健的免疫病因学研究——可能与抗层粘蛋白-1抗体、血管内皮生长因子及其可溶性受体相关

Immunopathogenic Study on the Effect of Recurrent Abortion on Life-long Health Care

目的本研究探讨抗层粘连蛋白(anti-Laminin-1,抗LN-1)、血管内皮生长因子(VEGF)及其可溶性受体(s Flt-1)与复发性流产和女性保健的关系。方法 URSA组选择2015年1月至2016年12月在北京市友谊医院妇产科复发性流产专科门诊就诊的URSA患者30例,所有患者就诊前均连续自然流产2次以上,流产都发生于妊娠20周以前。对照组选择同期156例无不良妊娠史的健康妇女,对照组妇女均无肝、肾疾病,无自然流产史、早产史、血栓或出血史、妊娠期高血压疾病史,并且至少有1次成功的妊娠分娩史。本研究采用ELISE方法测定抗LN-1抗体、VEGF、s Flt-1。结果病例组与对照组血清中抗LN-1抗体、VEGF的滴度没有统计学差异(P=0. 407,P=0. 435),但是复发性流产组与对照组s Flt-1的血清滴度有统计学差异(P <0. 01)。结论复发性流产的发生可能与s Flt-1的表达增高密切相关,s Fl T-1与VEGF亲合,可降低妊娠妇女血清内VEGF的含量,阻碍VEGF促进孕妇胎盘血管的生成,干扰孕妇早期胎盘的生长发育,导致孕期内复发性流产。复发性流产病患血清中的血管内皮生长因子及其可溶性受体的表达增高可能是导致早期胚胎停育引发RSA的关键因素之一。RSA是严重危害女性健康及其生命全程包括老年期健康的常见病,病因学复杂,阐明其病因是女性涉及生命全程的保健医学的关键。

Objective To investigate the relationship between anti-laminin-1(anti-LN-1),vascular endothelial growth factor(VEGF)and solublevascular endothendothelia growth factor receptor-1(sFlt-1)and recurrent spontaneous abortion in the study.Methods URSA group:From January 2015 to December 2016,30 patients with URSA who were treated in the Department of Obstetrics and Gynecology Recurrent spontaneous abortion in Beijing Friendship Hospital from January 2015 to December 2016,all patients had continuous spontaneous abortion before treatment.More than two times,abortion occurred before 20 weeks of gestation.In the control group,156 healthy women with no history of adverse pregnancy were selected as controls.The control group had no liver or kidney disease.No history of spontaneous abortion,premature birth,thrombosis or hemorrhage,hypertensive disorder complicating pregnancy,and at least one successful history of pregnancy and delivery.This study used the ELISE method to measure anti-LN-1 antibodies,VEGF,and sFlt-1.Results There was no significant difference in the anti-LN-1 antibody and VEGF between the case group and the control group(P=0.407,P=0.435),but the serum titer of sFlt-1 in the recurrent abortion group and the control group was Statistical difference(P<0.01).Conclusion①The occurrence of recurrent spontaneous abortion may be closely related to the increased expression of sFlt-1.sFlT-1 affinity with VEGF can reduce the serum VEGF content in pregnant women,prevent VEGF from promoting the formation of maternal blood vessels in pregnant women,and interfere with early pregnancy.The growth and development of the placenta leads to recurrent miscarriage during pregnancy.Increased expression of vascular endothelial growth factor and its soluble receptor in serum of patients with recurrent spontaneous abortion may be one of the key factors leading to RSA in early embryonic loss.②The cause of unexplained recurrent miscarriage is complex and may be the result of a combination of multiple factors.This is a result to further study the causes of some patients with recurrent spontaneous abortion,and may also solve the complications associated with placenta and the pathogenesis of the disease.