母-胎免疫识别低下型反复自然流产的供者及配偶白细胞免疫治疗  

Comparative Study of the Third Party and Paternal Leukocyte Immunization in Recurrent Spontaneous Abortion of Lowered Maternal Fetal Immuno Recognition

作　　者：李大金[1] 李超荆[1] 朱影[1] 王明雁[1] 王文君[1] 孙晓溪[1] 孟毅 邵彦红 

机构地区：[1]上海医科大学妇产科研究所生殖免疫室

出　　处：《中华妇产科杂志》1998年第10期597-600,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的比较供者及配偶白细胞免疫疗法治疗母胎免疫识别低下型反复自然流产（ＲＳＡ）的临床疗效。方法将４０例封闭抗体缺乏的ＲＳＡ患者随机分成两组，分别采用供者白细胞（静脉）与配偶白细胞（皮内加静脉）行免疫治疗。封闭抗体及抗其独特型抗体分析采用单向混合淋巴反应封闭试验、单向混合淋巴细胞反应封闭抑制试验、细胞毒试验及封闭抗体的流式细胞分析。结果经供者或配偶白细胞免疫后，封闭抗体及抗其独特型抗体呈明显升高（Ｐ＜０．０５，Ｐ＜０．０１）。再次妊娠成功率为８６．２％；新生儿体重为３３００±１１６ｇ（ｘ±ｓ），与同期正常妊娠组比较，差异无显著性（Ｐ＞０．０５）。对封闭抗体的动态分析显示，配偶白细胞免疫疗法优于供者白细胞免疫疗法；但再次妊娠成功率及新生儿体重在两者间差异无显著性。结论供者或配偶白细胞免疫，能有效刺激母胎免疫识别低下型ＲＳＡ患者产生封闭抗体及抗其独特型抗体，并导致妊娠成功。白细胞免疫疗法对新生儿体重无明显影响。Objective To compare curative effect of leukocyte immunization to recurrent spontaneous aborters(RSA) with lowered maternal fetal immuno recognition between transfusions of the third party leukocyte rich erythrocyte concentrates and injections of paternal leukocytes. Methods Forty RSA patients with lack of blocking antibodies were randomly divided into two groups. Blocking antibodies were analysed by one way mixed lymphocyte reaction blocking test and complement dependent cytotoxic test, anti idiotypic antibodies to blocking antibodies by one way mixed lymphocyte reaction blocking inhibiting test, and flow cytometry evaluation of blocking antibodies were used to investigate effect of blocking antibodies on the CD antigens of T cells. The immunization was achieved by transfusions of the third party leukocytes or injections of the paternal leukocytes for 3 times or more at an interval of 4 weeks. Results It was found in dynamical analyses that levels of the blocking antibodies and their anti idiotypic antibodies increased significantly after the aborters had been immunized. The successful pregnancy rate was 86.2% following immunization, and body weight of the infants was 3 300±116 g( ±s ), with no significant difference to 3 279.0±113.8 g of the infants from normal pregnancy. According to dynamics of blocking antibodies and their anti idiotypic antibodies, the paternal leukocyte immunotherapy appeared superior to the third party one, but the successful pregnancy rate and the body weight of infants were with not different between the two immunotherapy groups. Conclusion The third party and paternal leukocyte immunization could effectively stimulate the aborters of lowered maternal fetal immuno recognition to produce blocking antibodies and their anti idiotypic antibodies, leading to successful pregnancy. The immunotherapy does not apparently influence the body weight of the delivered infants.

关 键 词：习惯性流产 免疫疗法 白细胞 自然流产 

分 类 号：R714.210.5[医药卫生—妇产科学]