丈夫淋巴细胞主动免疫治疗对不明原因复发性流产和反复着床失败的疗效  

Effect of parental lymphocyte immunotherapy on recurrent spontaneous abortion and repeated implantation failure

作　　者：张燕[1] 赵璟[1] 李洁[1] 肖卓妮[1] ZHANG Yan;ZHAO Jing;LI Jie;XIAO Zhuoni(Reproductive Medicine Center,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院生殖医学中心,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2024年第6期710-716,共7页Medical Journal of Wuhan University

基　　金：国家自然科学基金资助项目(编号:81471455);湖北省联合基金-重点项目(编号:2020LHZ012)。

摘　　要：目的:观察分析丈夫淋巴细胞主动免疫治疗(LIT)对不明原因复发性流产(uRSA)和反复着床失败(RIF)的妊娠结局的影响。方法:回顾性收集、分析具有uRSA、RIF的女性接受丈夫外周血淋巴细胞主动免疫治疗后封闭抗体转归情况及其妊娠结局,共收集2019年1月—2020年12月在武汉大学人民医院生殖中心250例因uRSA和RIF而行LIT的患者作为研究对象,其中uRSA组181例,RIF组69例。结果:(1)经过LIT后,治疗患者的整体封闭抗体转阳率为86.8%;其中uRSA组的封闭抗体转阳率为86.2%,RIF组的封闭抗体转阳率为88.4%;(2)经过LIT治疗后,uRSA患者的妊娠率为90.06%,流产率为7.66%,活产率为89.57%;RIF患者的妊娠率为66.67%,流产率为6.52%,活产率为93.48%。uRSA患者封闭抗体转阳组(+)与持续阴性组(-)的临床妊娠率、流产率、活产率差异无统计学意义(P>0.05);RIF患者封闭抗体转阳组(+)与持续阴性组(-)相比,临床妊娠率明显提高(72.1%vs 25.0%,P<0.05),流产率与活产率差异无统计学意义(P>0.05);(3)57名uRSA患者经过LIT治疗后行IVF助孕,其中<38岁的患者47名,与≥38岁患者相比,其获卵数(14.38±6.31 vs 9.20±5.08)、2PN受精数(10.28±4.89 vs 6.20±3.82)、囊胚形成率(56.61%vs 38.64%)、胚胎着床率(51.04%vs 22.73%)、临床妊娠率(85.11%vs 50.00%)、活产率(92.5%vs 60.0%)明显升高,流产率降低(7.5%vs 40.0%),差异具有统计学意义(均P<0.05);(4)64名RIF患者经过LIT治疗后行IVF助孕,其中<38岁的患者56名,与≥38岁患者相比,其获卵数(13.39±6.48 vs 6.50±5.10,P=0.006)、2PN受精数(9.98±5.23 vs 4.75±3.07,P=0.008)、可移植胚胎数(6.18±3.54 vs 2.88±1.27,P=0.012)较高且有统计学差异;而胚胎着床率(44.74%vs 20.00%,P=0.068)、临床妊娠率(69.64%vs 37.50%,P=0.073)、活产率(94.87%vs 100%,P=0.688)较高,流产率较低(5.13%vs 0%,P=0.688),但差异没有统计学意义。结论:LIT能明显改善uRSA与RIF患者的妊娠结局。LIT强化治疗后封闭抗体的转�Objective:To investigate the effects of lymphocyte immunotherapy(LIT)on the outcomes of re‑current spontaneous abortion and repeated implantation failure.Methods:The cases with a history of unexplained recurrent spontaneous abortion(uRSA)and recurrent implantation failure(RIF)were included,and all the cases received active immunotherapy with peripheral blood lymphocytes from their husbands.Their retrospectively blocking antibody outcomes and pregnancy outcomes were studied.A total of 250 patients who underwent LIT due to uRSA and RIF in the Reproductive Center of Renmin Hospital of Wuhan University from January 2019 to December 2020 were collected as the research objects,including 181 patients in the uRSA group and 69 patients in the RIF group.Results:①After LIT,the overall blocking antibody conversion rate was 86.8%(217/250).The conversion rate of blocking antibodies in the uRSA group was 86.2%(156/181),and that in RIF group was 88.4%(61/69).②After LIT,the pregnancy rate,abortion rate,and live birth rate of uRSA patients were 90.06%,7.66%,and 89.57%,respectively.The pregnancy rate of the RIF patients was 66.67%,the abortion rate was 6.52%,and the live birth rate was 93.48%.There was no significant difference in the clinical pregnancy rate,abortion rate,and live birth rate between the positive blocking antibody group(+)and the persistent negative group(-)in RSA patients(P>0.05).③A total of 57 uRSA patients underwent IVF after LIT,including 47 patients aged<38 years.Compared with those in the patients aged≥38 years,the number of oocytes(14.38±6.31 vs 9.20±5.08,P=0.018),and the number of 2PN fertilization(10.28±4.89 vs 6.20±3.82,P=0.016)were significantly more,and the blastocyst formation rate(56.61%vs 38.64%,P=0.016),embryo implantation rate(51.04%vs 22.73%,P=0.003),clinical pregnancy rate(85.11%vs 50%,P=0.013),and live birth rate(92.5%vs 60%,P=0.029)were significantly higher in the patients aged<38 years,while the abortion rate was less(7.5%vs 40%,P=0.029).④A number of 64 RIF patients underwent IV

关 键 词：淋巴细胞主动免疫治疗 不明原因复发性流产 反复着床失败 妊娠结局 

分 类 号：R714.21[医药卫生—妇产科学]