自身免疫型复发性流产诊治中的争议与展望

Autoimmune recurrent spontaneous abortion:controversy and outlook

复发性流产(recurrent spontaneous abortion,RSA)是一种严重威胁女性身心健康的疾病,也是降低我国育龄期女性生育能力和妇幼健康水平的重要原因。RSA病因复杂,涉及染色体异常、自身免疫异常、同种免疫紊乱、血栓前状态、内分泌功能异常、解剖学异常等多方面,且尚有约25%的患者无法明确病因,故临床诊断和治疗十分困难,诊疗不及和过度诊疗的现象普遍存在。自身免疫异常是RSA最为重要的病因之一,约占RSA全部病因的30%,但自身免疫型RSA存在诊断标准不明确、检查指标不统一、治疗方法不确切等问题,故在临床实践中存在诸多争议。本文就目前自身免疫型RSA临床诊治过程中存在的争议和热点问题及现有研究成果进行了解读与述评、对未来的发展方向进行了展望和提出了自身免疫型RSA的分级筛查策略。

Recurrent spontaneous abortion(RSA)is a disease which seriously threaten the physical and mental health of pa⁃tients,and it is also an important factor leading to the impairment of fertility in women of childbearing age.The etiology of RSA includ⁃ing chromosomal abnormalities,autoimmune abnormalities,maternal-fetal immune disorders,thrombophilia,endocrine dysfunction and abnormal anatomy of reproductive system,and about 25%of patients have no clear etiology.Therefore,the diagnosis and treatment of RSA are of difficulties,and inadequate or excessive diagnosis and treatment are common.Autoimmune abnormalities are one of the most important causes of RSA,accounting for about 30%of all causes of RSA.However,there are some uncertainties in diagnostic criteria,examination and treatment of autoimmune RSA.This article provided an analysis and commentary on the current controversies and hot topics in the clinical diagnosis and treatment of autoimmune RSA,as well as existing research results.It also provided an outlook on fu⁃ture development directions and proposed a classification and screening strategy for autoimmune RSA.