从免疫细胞的变化探讨不明原因复发性流产的病因和治疗

Explore the etiology and treatment of unexplained recurrent abortion from the changes of immune cells

不明原因复发性流产作为生殖医学领域的疑难病症,其发病率一直呈现上升趋势。因其原因不明、机制不定,治疗便无从下手。目前国内外对其研究主要围绕免疫因素,而免疫细胞作为较直观的载体,有望通过检测其变化为明确不明原因复发性流产的病因和治疗提供方向。通过免疫球蛋白、间充质干细胞(MSCs)、免疫抑制剂等治疗后,不明原因复发性流产患者的高自然杀伤细胞(NK)及其被激活的细胞毒性、高辅助性T细胞(Th)1/Th2、Th17、调节性T细胞(Tregs)数量和功能的损伤或缺失、高巨噬细胞(M)1/M2、树突状细胞(DCs)功能和分化异常等情况分别得到改善。此外,食用禁忌保护特定母体人类主要组织相容性复合体(MHC)产生的调节性T细胞(Tr)和效应T细胞(Te),在新生儿刚出生后的关键时期建立有效的T细胞平衡;对母体补充醋酸盐的摄入,减少致肥饮食摄入、升高母乳miR103-3p水平,管理体重,能分别改善后代和母体上述免疫细胞的失衡。两者联合可作为免疫细胞平衡可持续发展的研究导向。

The incidence of unexplained recurrent abortion, a difficult disease in reproductive medicine, has been on the rise. Because its reason is unclear, the mechanism is indefinite, the treatment then is unable to start. At present, the research is mainly about the immune factors, and the immune cells, as a more intuitive carrier, are expected to provide direction for the etiology and treatment of unknown recurrent miscarriage by detecting its changes. After treatment with immunoglobulin, mesenchymal stem cell, and immunosuppressants, high natural killer cells(NK) and activated cytotoxicity, high T helper cells(Th)1/Th2, Th17, damage or loss of regulatory T cells(Tregs) number and function, high macrophages(M)1/M2, dendritic cells(DCs) function and abnormal differentiation were improved in patients with unexplained recurrent abortion. In addition, by protecting the regulatory T cells(Tr) and effector t cells(Te) produced by specific maternal human major histocompatibility complex with contraindications, an effective T cell balance is established in the critical period immediately after birth;the imbalance of these immune cells in the offspring and the mother can be improved by feeding the mother with acetate, reducing the intake of fattening diet, raising the level of miR103-3p in breast milk, and managing the body weight;the combination of the two can be used as a research direction for the balance and sustainable development of immune cells.