反复胚胎植入失败和流产与子宫内膜免疫因素  

Immune factors of human endometrium in repeated implantation failure and recurrent spontaneous abortion

作　　者：王晓秋[1] 李大金[1] WANG Xiao-Qiu;LI Da-Jin(Obstetrics and Gynecology Hospital of Fudan Universi-ty,Shanghai 200011,China)

机构地区：[1]复旦大学附属妇产科医院,上海200011

出　　处：《中国实用妇科与产科杂志》2020年第11期1036-1040,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家自然科学基金(81471548,81490744)。

摘　　要：胚胎着床及发育是一个母-胎相互识别、相互适应的复杂过程。在此过程中,滋养细胞表达胚胎抗原并分泌细胞因子,逃避母体免疫系统的攻击,母体蜕膜特征性免疫细胞的富集形成母-胎界面独特的免疫微环境,从而有利于胚胎着床及发育。虽然近年来体外受精-胚胎移植(IVFET)的成功率已有很大提高,反复种植失败(RIF)仍是困扰辅助生殖技术发展的难题。胚胎作为同种异体移植物不被母体免疫系统排斥是妊娠建立和维持的关键,母-胎免疫调节异常可致复发性流产(RSA),给患者夫妇身心及经济均带来极大负担。随着生殖免疫学的发展,子宫内膜免疫因素在RIF和RSA发病中的作用日益受到关注,针对性的免疫治疗也在RIF和RSA的治疗方案中扮演着越来越重要的角色。文章就RIF和RSA子宫内膜免疫因素的分子病理机制及其免疫治疗的当今认识进行阐述,以期为未来的科学研究及临床治疗提供参考。Embryo implantation and development is a complex process of mutual recognition and adaptation between mother and fetus.In this process,trophoblasts express embryonic antigens and secrete cytokines to escape the attack of maternal immune system.The enrichment of characteristic immune cells in decidua forms a unique immune microenvironment at the maternal-fetal interface,which is beneficial to embryo implantation and development.Although the success rate of IVF-ET has been greatly improved in recent years,recurrent implantation failure(RIF)is still a problem that puzzles the development of assisted reproductive technology.That the fetus,as an allograft,is not rejected by the maternal immune system is the key to the establishment and maintenance of pregnancy.Abnormal maternal-fetal immune regulation can cause recurrent spontaneous abortion(RSA),which brings physical and mental and economic burden to the couple.With the development of reproductive immunology,the role of endometrial immune factors in the pathogenesis of RIF and RSA has attracted increasing attention.The immunotherapy also plays an increasingly important role in the treatment of these diseases.This article will expound the molecular mechanisms of endometrial immune factors in RIF and RSA and the current understanding of immunotherapy,in order to provide a reference for future scientific research and clinical treatment.

关 键 词：反复种植失败 复发性流产 子宫内膜 免疫因素 

分 类 号：R714.21[医药卫生—妇产科学]