肿瘤坏死因子-α及其拮抗剂在复发性流产中的研究进展

Research progress of tumor necrosis factor-alpha and its antagonist in recurrent spontaneous abortion

肿瘤坏死因子-α作为促炎Th1细胞因子,在调节着床、胎盘形成和最终妊娠结局的炎症机制中起着重要作用。妊娠早期肿瘤坏死因子-α的适度增加或可对胚胎着床有益,但其过度表达可激活细胞毒性T细胞和自然杀伤细胞等,介导滋养层细胞的凋亡损伤与母体高凝状态的产生,最终导致流产的发生。近年来,肿瘤坏死因子-α在复发性流产中的作用机制引发了生殖医学领域的热议,肿瘤坏死因子-α是否应该作为复发性流产患者的常规筛查内容,肿瘤坏死因子-α拮抗剂是否能够改善妊娠结局,其应用于母体和胎儿是否能够保障近期与远期安全性。本文将从以上问题出发,对肿瘤坏死因子-α在复发性流产中的研究进展和肿瘤坏死因子-α拮抗剂在复发性流产患者中的应用疗效及安全性进行综述,以期为临床提供一些诊疗思路和依据。

As a pro-inflammatory Th1 cytokine,tumor necrosis factor-alpha plays an important role in regulating the inflammatory mechanism of implantation,placental formation and final pregnancy outcome.The moderate increase of tumor necrosis factor-alpha in early pregnancy may be beneficial to embryo implantation,but its overexpression can activate cytotoxic T cells and natural killer(NK)cells,mediate the apoptotic damage of trophoblast cells and the production of maternal hypercoagulable state,and finally lead to abortion.In recent years,the mechanism of tumor necrosis factor-alpha in recurrent spontaneous abortion has aroused heated debate in the field of reproductive medicine.Whether tumor necrosis factor-alpha should be used as a routine screening content for patients with recurrent spontaneous abortion?Whether tumor necrosis factor-alpha antagonists can improve pregnancy outcome?Whether its application in mother and fetus can ensure short-term and long-term safety?Starting from the above problems,this paper will review the research progress of tumor necrosis factor-alpha in recurrent spontaneous abortion and the efficacy and safety of tumor necrosis factor-alpha antagonist in patients with recurrent spontaneous abortion,in order to provide some ideas and basis for clinical diagnosis and treatment.