蜕膜自然杀伤细胞在反复妊娠丢失中的作用及相关治疗  

The Role of Decidual Natural Killer Cells in Recurrent Pregnancy Loss and Related Treatment

作　　者：王璐 李洋[1] 杜伯涛(审校)[1] WANG Lu;LI Yang;DU Bo-tao(Reproductive Center,The Second Affiliated Hospital of Harbin Medical University,Harbin 150086,China)

机构地区：[1]哈尔滨医科大学附属第二医院生殖中心,150086

出　　处：《国际生殖健康／计划生育杂志》2022年第3期219-224,共6页Journal of International Reproductive Health/Family Planning

摘　　要：反复妊娠丢失(recurrent pregnancy loss,RPL)的发生率约为1%~5%。近年研究发现,母胎界面免疫微环境对妊娠结局有重要影响。蜕膜自然杀伤(decidual natural killer,dNK)细胞作为母胎界面重要的免疫细胞,可产生多种细胞因子,调节滋养细胞侵袭,促进子宫螺旋动脉重塑,参与妊娠早期母胎界面免疫耐受的建立,从而维持妊娠。而RPL患者的dNK细胞呈高活跃状态,其活性及功能发生改变,可能影响妊娠的免疫环境,进而导致妊娠失败。目前,通过改善dNK细胞活性及功能进而影响母胎界面微环境的治疗包括静脉滴注丙种球蛋白或脂肪乳、粒细胞集落刺激因子、糖皮质激素、间充质干细胞、枸橼酸西地那非和西罗莫司等,已成为RPL治疗中的新研究方向。The incidence of recurrent pregnancy loss(RPL)is about 1%-5%.The immune microenvironment at the maternal-fetal interface has a vital impact on the pregnancy outcomes.Decidual natural killer(dNK)cells,as important immune cells at the maternal-fetal interface,can produce a variety of cytokines,regulate trophoblast cells invasion,promote uterine spiral arteries remodeling,and participate in the establishment of immune tolerance at the maternal-fetal interface in early pregnancy,so as to maintain pregnancy.However,the dNK cells are highly activated in RPL patients.The increased activity and changed function of dNK cells may affect the immune environment of pregnancy,thereby leading to pregnancy failure.At present,the therapeutic regimens that affects the microenvironment of the maternal-fetal interface by improving the activity and function of dNK cells,including intravenous immunoglobulin G and lipid emulsion,granulocyte colony-stimulating factor,glucocorticoid,mesenchymal stem cells,sildenafil citrate and Sirolimus have become new research directions in the treatment of RPL.

关 键 词：胚胎丢失 自身免疫 蜕膜 杀伤细胞 天然 免疫耐受 免疫疗法 

分 类 号：R714.2[医药卫生—妇产科学]