低剂量静脉注射人免疫球蛋白治疗不明原因反复流产的效果及对可溶性人白细胞抗原G的影响  

Effectiveness of Intravenous Immunoglobulin Therapy in Treating Unexplained Recurrent Spontaneous Abortion and Its Effect on the Level of Serum Soluble Human Leucocyte Antigen G

作　　者：孙晓光[1] 刘欣燕[1] 朱锐 范光升[1] 张颖[1] 陈凤领[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院妇产科,北京1007302 [2]成都蓉生药业有限责任公司市场部,成都610023

出　　处：《中国医学科学院学报》2010年第5期483-487,共5页Acta Academiae Medicinae Sinicae

基　　金：首都医学发展科研基金(2002-3027);成都蓉生药业有限责任公司科研基金(2005-4)~~

摘　　要：目的评估低剂量静脉注射人免疫球蛋白(IVIG)治疗不明原因反复流产(URSA)的效果及对外周血可溶性人白细胞抗原G(sHLA-G)的影响。方法将60例URSA患者分为试验组和对照组两组,每组30例。试验组在妊娠前静脉给予IVIG0.2g/kg;确定妊娠后给予同等剂量IVIG,每4周1次,至妊娠20周。对照组给予传统中药或孕激素治疗。观察两组的活产率和有效率(超过以往妊娠4周及以上为有效)。于治疗前和妊娠6～8周随机留取试验组和对照组静脉血各15份,同期健康育龄期未孕及早孕6～8周妇女的静脉血标本各20份。采用酶联免疫吸附法检测血清sHLA-G、干扰素γ(IFN-γ)、白细胞介素-2(IL-2)和白细胞介素-10(IL-10)水平。结果试验组应用IVIG后的妊娠率为93.3%(28/30)。试验组的活产率和有效率分别为85.7%(24/28)和92.9%(26/28),明显高于对照组的56.7%(17/30)(P=0.021)和63.3%(19/30)(P=0.011)。试验组应用IVIG后有1例(3.3%)患者发生轻微恶心,减慢IVIG输入速度后反应消失。对照组和试验组患者孕前血清sHLA-G水平分别为(61.37±35.57)和(62.70±37.24)U/ml,明显低于健康育龄期妇女的(88.49±25.37)U/ml(P<0.05)。妊娠后试验组患者的血清sHLA-G和IL-10水平分别为(34.19±14.21)U/ml和(11.71±2.75)pg/ml,明显高于对照组的(23.71±12.83)U/ml(P=0.043)和(8.71±3.01)pg/ml(P=0.008)。结论孕前后应用低剂量IVIG治疗URSA安全有效,其可能是通过上调患者体内sHLA-G和IL-10水平来改善胚胎发育。Objective To explore the effectiveness of intravenous immunoglobulin（IVIG）in treating patients with unexplained recurrent spontaneous abortion（URSA）and the effect of IVIG on the level of solublehuman leucocyte antigen G（sHLA-G）.Methods This prospective trial conducted at PUMC Hospital between 2004 and 2008 included 60 women with URSA.The patients were allocated into IVIG group（30 cases）and control group（30 cases）.IVIG was intravenously used before conception at a dose of 0.2g/kg;once pregnancy was confirmed,IVIG was continued every 4 weeks till the 20th gestational week.Traditional Chinese medicine or/and progesterone were used in control group.The outcome of pregnancy was evaluated by live birth rate and effective rate（defined as the embryo living 4 week longer than previous pregnancy）.Serum samples were collected randomly before pregnancy and in the 6th-8th gestational week from IVIG group（15 samples）,control group（15 samples）,and healthy women（20 samples）.The levels of sHLA-G,interferonγ（IFN-γ）,interleukin-2（IL-2）,and interleukin-10（IL-10）were determined by enzyme-linked immunosorbant assay（ELIZA）.Results The pregnancy rate was 93.3% in IVIG group.The live birth rate and effective rate were 85.7%（24/28）and 92.9%（26/28）in IVIG group,which were significantly higher than those in control group [56.7%（17/30）（P=0.021）and 63.3%（19/30）（P=0.011）].Emesis occurred in one woman（3.3%）in IVIG group had during IVIG infusion but was relieved by lowering the speed of infusion.The mean sHLA-G level was（61.37±35.57）U/ml in control group and（62.70±37.24）U/ml in IVIG group（P〉0.05）;both of them were significantly lower than that of healthy women（88.49±25.37）U/ml（P〈0.05）.After pregnancy was achieved,the levels of sHLA-G and IL-10 were（34.19±14.21）U/ml and（11.71±2.75）pg/ml,respectively in the IVIG group,which were significantly higher than those in control group [（23.71±12.83）U/ml and（8.71±3.01）pg/ml,re

关 键 词：静脉注射人免疫球蛋白 免疫治疗 不明原因反复流产 可溶性人白细胞抗原G 

分 类 号：R715.2[医药卫生—妇产科学]