免疫治疗对RPL患者妊娠结局的影响及安全性研究  

Effect and safety of immunotherapy on pregnancy outcome in patients with RPL

作　　者：茹慧波 董九华 吴纯 王琇 王树松 杜丽荣 RU Huibo;DONG Jiuhua;WU Chun;WANG Xiu;WANG Shusong;DU Lirong(Hebei Reproductive Health Hospital,Hebei Key Laboratory of Reproductive Medicine,Shijiazhuang 050071,China)

机构地区：[1]河北省生殖健康医院,河北省生殖医学重点实验室,石家庄050071

出　　处：《中国免疫学杂志》2024年第1期152-155,162,共5页Chinese Journal of Immunology

基　　金：河北省省级科技计划(223777151D,21377799D);河北省中医药类科研计划课题(2021205)。

摘　　要：目的:回顾性分析合并免疫因素异常的反复妊娠丢失(RPL)患者临床用药情况,评价免疫治疗的临床疗效及安全性。方法:对2021年1月至2022年4月河北省生殖健康医院门诊RPL病例资料进行回顾性队列研究,从妊娠结局、不良反应、子代出生缺陷评价免疫治疗的疗效及安全性。结果:根据指南进行病因筛查,纳入自身免疫异常和/或免疫指标异常者192例,妊娠丢失2次组早期流产率4.16%,低于妊娠丢失3次组(16.66%),前者12周持续妊娠率为89.58%,28周持续妊娠率为86.45%,均显著高于后者(75.00%、71.87%)。根据RPL患者妊娠12周前免疫调节药物暴露情况进行分组,其妊娠结局、不良反应发生率、子代出生缺陷率差异均无统计学意义(P>0.05)。结论:免疫治疗可有效降低免疫性RPL患者流产再发风险,提高持续妊娠率。个性化免疫治疗可使合并免疫因素的RPL患者达到预期保胎效果。Objective:To evaluate clinical efficacy and safety of immunotherapy by retrospectively analyzing clinical medica-tion of patients with recurrent pregnancy loss(RPL)complicated with abnormal immune factors.Methods:A retrospective cohort study was conducted on RPL cases in outpatient department of Hebei Reproductive Health Hospital from January 2021 to April 2022.Efficacy and safety of immunotherapy were evaluated from pregnancy outcome,adverse reactions and birth defects of offspring.Results:According to guidelines,192 cases with abnormal autoimmunity and/or immune indicators were included.Early abortion rate was 4.16%in group of two lost pregnancies,which was lower than that in group of three lost pregnancies(16.66%).Twelve week sus-tained pregnancy rate was 89.58%in the former group,and 28 week sustained pregnancy rate was 86.45%,which were significantly higher than those in the latter group(75.00%,71.87%).RPL patients were divided into groups according to their exposure to immuno-modulatory drugs before 12 weeks of pregnancy.There was no significant difference in pregnancy outcome,adverse reaction rate and birth defect rate of their offspring(P>0.05).Conclusion:Immunotherapy can effectively reduce risk of recurrent abortion and increase rate of persistent pregnancy in patients with immune RPL.Personalized immunotherapy can make RPL patients with immune factors achieve expected effect of fetal protection.

关 键 词：反复妊娠丢失 免疫球蛋白 生物制剂 妊娠结局 

分 类 号：R714.21[医药卫生—妇产科学]