不明原因复发性流产患者的治疗研究现状与展望

Current status and outlook of research in treatment of unexplained recurrent spontaneous abortion

复发性流产(RSA)患者是指连续发生≥2次自然流产者,全球RSA发病率为1%~5%。约50%RSA患者为病因不明者,被称为不明原因复发性流产(URSA)患者。URSA的发生与母-胎免疫失衡有关,但是其确切病因及发病机制迄今尚未阐明,目前对URSA患者仍然缺乏统一的有效治疗手段。临床用于URSA患者的淋巴细胞免疫治疗(LIT)与静脉输注免疫球蛋白(IVIG)、免疫抑制剂、免疫调节剂、孕激素及抗凝治疗等方法多为试验性方法,部分疗法的有效性和安全性均尚存争议。笔者拟就URSA患者诊断和治疗,特别是LIT、IVIG治疗、免疫抑制剂治疗、粒细胞集落刺激因子(G-CSF)治疗、脂肪乳治疗、孕激素治疗、抗凝治疗及维生素D、中药与胚胎种植前遗传学检测-非整倍体筛查(PGT-A)技术治疗的最新研究进展进行阐述,旨在为临床对URSA患者的诊疗决策提供参考。

Recurrent spontaneous abortion (RSA) is typically defined as two or more consecutive spontaneous miscarriage with global incidence of 1%-5%. Among them, about 50% cases were with unknown causes, namely unexplained recurrent spontaneous abortion (URSA). Studies showed that URSA may be related to the maternal-fetal immune imbalance while the exact etiology and pathogenesis underlying URSA remains unclear. At present, it is still lack of recognized effective treatments for URSA. Various treatments such as lymphocyte immunotherapy (LIT), intravenous immunoglobulin (IVIG), immunosuppressant, immunomodulator, progesterone and anticoagulant therapy have been tried in URSA women although efficacy and safety of certain treatments are controversial. Here we summarize current status and advances in research on diagnosis and treatments of URSA, especially treatments such as LIT, IVIG, immunosuppressant, granulocyte colony-stimulating factor (G-CSF), intralipid, progesterone, anticoagulant, vitamin D, herbal medicine and preimplantation genetic testing for aneuploidies (PGT-A), aiming to provide a reference for doctors on choosing strategies for URSA patients.