羊水栓塞症的发病机制研究进展

Advances in the pathogenesis of amniotic fluid embolism

羊水栓塞症(AFE)是产科罕见病,病死率高,预后极差。本文简要回顾了近年来其病理生理机制的研究进展,重点探讨了肥大细胞、补体系统和急性子宫肌炎在发病过程中的作用。AFE的发病机制可以分为三大类型,一是机械阻塞型,主要是由于胎儿抗原和羊水成分的机械性阻塞,尤其是肺血管的机械阻塞所致,所占比例较小;其次是过敏样反应型,由于母体对胎儿抗原和羊水成分的过敏样反应所引起,与抗原的剂量无关;三是DIC型,由于肥大细胞兴奋、补体激活等释放激活的活性介质,激活了凝血系统,导致凝血因子大量消耗,引起DIC的出现,此型可能是过敏样反应型的进一步发展。在这些过程中,肥大细胞的活化、补体激活发挥着关键作用。在子宫,由于机械性阻塞、炎性介质的激活所引起的急性子宫肌炎在子宫张力丧失中发挥着重要作用,并进而引起子宫的产后出血和DIC。

Amniotic fluid embolism (AFE) is a rare obstetric disease with high mortality and poor prognosis.This article reviews the advances in the understanding of the pathogenesis,especially the roles of mast cells,complement system and acute myositis.AFE can be divided into three types.Mechanical obstruction type,caused by obstruction of vessels by fetal antigen and amniotic fluid components,especially the pulmonary vessels,accounts for a small proportion.Anaphylactoid reaction type,is caused by maternal allergic reaction to fetal antigen and amniotic fluid components,regardless the amounts of antigens.DIC type,induced by activation of mast cells and complement systems,activating the coagulation system,results the consumption of coagulation factors,and causes the emergence of DIC.This type may be the advanced stage of allergic reaction type.In these processes,mast cell activation and complement activation play a key role.In uterus,acute myositis caused by mechanical obstruction and activation of inflammatory mediators plays an important role in the loss of uterine tension,and it causes uterine postpartum hemorrhage and DIC.