配偶淋巴细胞体外诱生免疫及地屈孕酮治疗不明原因反复自然流产的疗效比较及对围产期母婴的影响  

Evaluation of curative effect and safety of treatments for unexplained recurrent spontaneous abortion by paternal lymphocyte in vitro induced immunization and dydrogesterone

作　　者：袁敏敏[1] 杜美蓉[1] 王明雁[1] 孟毅[1] 段忠亮[1] 李大金[1] 

机构地区：[1]复旦大学附属妇产科医院研究所,上海200011

出　　处：《生殖与避孕》2015年第12期834-839,共6页Reproduction and Contraception

基　　金：上海卫生系统先进适宜技术推广项目(2013SY034);国家自然科学基金面上项目(31171437)

摘　　要：目的:探讨配偶淋巴细胞体外诱生免疫联合地屈孕酮治疗对不明原因反复自然流产(URSA)患者再次妊娠结局及对孕妇围产期并发症的发生和新生儿发育的影响。方法:随访分析254例URSA患者,其中A组84例接受配偶淋巴细胞体外诱生免疫治疗;B组86例接受地屈孕酮治疗;C组84例接受体外诱生免疫联合地屈孕酮治疗;比较3组患者接受治疗后的再次妊娠成功率,以及围产期孕产妇的情况和新生儿的发育。结果:3组患者再次妊娠成功率分别为89.3%、70.9%和92.8%。B组低于其他各组,且差异有统计学意义(P<0.05)。3组患者新生儿的分娩孕周无统计学差异(P>0.05);足月新生儿出生体质量及身长组间无统计学差异(P>0.05);各组与正常参照标准比较差异无统计学意义(P>0.05)。3组间围产期妊娠并发症及新生儿畸形的发生率与流行病学调查数据比较无统计学差异(P>0.05)。结论:与单用地屈孕酮治疗比较,配偶淋巴细胞体外诱生免疫,或诱生免疫联合地屈孕酮治疗显著增加URSA患者再次妊娠的成功率;3种方法治疗均不影响新生儿生长发育;与正常妊娠相比,3种治疗均不增加孕妇围产期妊娠并发症与新生儿畸形率。Objective： To evaluate the efficacy and safety of treatments of unexplained recurrent spontaneous abortion （URSA） by paternal lymphocyte in vitro induced immunization combined with dydrogesterone on the pregnant outcome as well as on the influence of perinatal complication for the pregnant woman and neonatal development. Methods： A total of 254 URSA patients were followed up and analyzed. Among them, 84 cases treated with paternal lymphocyte induced immunization were defined as group A; 86 cases treated orally with dydrogesterone were ：recruited as group B; 84 cases who accepted therapy by lymphocyte induced immunization combined with dydrogesterone were classified as group C. The pregnancy outcome after treatment as well as the maternal situation and neonatal development were recorded and compared among three groups. Results： The pregnancy success rate of groups A, B, C was 89.3%, 70.9% and 92.8%, respectively, which was significantly lower in group B than in other groups （P〈0.05）. There was no significant difference （P〉0.05） of delivery gestational week of the newborns among the three groups. Full-term birth weight and body length among the three groups had no significant difference （P〉0.05）. Comparison of newborn birth weight and body length with normal reference standards showed no significant difference （P〉0.05）. Conclusion： Paternal lymphocyte induced immunization or induced immunization combined with dydrogesterone can significantly improve the pregnancy outcome of URSA compared with only given oral dydrogesterone alone. All the three methods had no adverse effect on the occurrence of both perinatal complication and growth of newborns.

关 键 词：不明原因反复自然流产(URSA) 地屈孕酮 配偶淋巴细胞体外诱生免疫 

分 类 号：R714.21[医药卫生—妇产科学]