摘要
目的探讨孕前淋巴细胞主动免疫疗法(LIT)治疗不明原因复发性流产(URSA)的最适疗程和疗效监测指标。方法选取2015年6月至2017年3月于中国医科大学附属盛京医院妇产科门诊就诊的确诊为URSA的孕前患者92例,分为2组:LIT组74例(孕前行LIT治疗)和对照组18例(孕前未进行LIT治疗)。LIT组治疗2次即1个疗程后,若封闭抗体(APLA)与自身免疫性抗体(AIA)任意一项转阳,终止LIT治疗,为LIT-A组(29例);未转阳者(45例)中13例拒绝继续治疗,为LIT-B组,余32例继续进行LIT治疗2次,为LIT-C组。LIT治疗4次后无论APLA是否转阳,均备孕。全部患者随访至妊娠28周以上,比较LIT组和对照组的妊娠成功率,并检测LIT组治疗前后APLA和AIA的变化。结果 LIT组妊娠成功率(67.6%,50/74)显著高于对照组(38.9%,7/18)(P<0.05)。LIT-C组妊娠成功率(84.4%,27/32)显著高于LIT-B组(53.8%,7/13)(P<0.05);与治疗前相比,LIT组治疗2次后APLA(21.6%,16/74)与AIA(21.6%,16/74)转阳率显著增加(P<0.05);LIT治疗4次后,与治疗前相比,LIT组APLA(36.5%,27/74)与AIA(33.8%,25/74)的累积转阳率显著增加(P<0.05)。结论孕前进行LIT治疗有助于提高URSA患者妊娠率成功率;LIT治疗2次后,部分患者AIA或APLA转阳,应停止LIT治疗;若APLA与AIA均未转阳,再进行2次LIT治疗更有利于妊娠成功;LIT治疗4次后,若患者APLA仍未转阳,为避免AIA进一步转阳,应停止LIT继续治疗;APLA转阳与妊娠成功无显著相关性,AIA有望辅助APLA作为监测LIT疗效和调整疗程的有效指标。
Objective To investigate the optimal course and monitoring indicators of lymphocyte immunotherapy（LIT）before pregnancy in patients with unexplained recurrent spontaneous abortion（URSA）.Methods A total of 92 patients with URSA were treated in the Department of Obstetrics and Gynecology,Shengjing Hospital,China Medical University,from June 2015 to March 2017 and they were included for the prospective study.The patients were divided into two groups firstly：control group（n=18,LIT untreated group）and LIT group（n=74）,2 times of LIT treatment for a course.If either APLA or AIA turned positive（n=29,LIT-A group）during the first course of LIT therapy,then the LIT therapy was stopped and the patients were prepared for pregnancy.Both AIA and APLA negative groups were suggested next LIT course,among whom 13 cases refused continuing next course（n=13,LIT-B Group）,and 32 patients agreed（n=32,LITC group）.After LIT therapy for 4 times,the patients were prepared for pregnancy whether APLA was positive or not. All patients were followed up for more than 28 weeks. The success rate of pregnancy in LIT group and control group was compared. The changes of APLA and AIA in the treatment group before and after treatment were also observed.Results The successful pregnancy rate in LIT group（67.6%,50/74）was significantly higher than in control group（38.9%,7/18）（P〈0.05）.The successful pregnancy rate in LIT-C group（84.4%,27/32）was significantly higher than in LIT-B group（53.8%,7/13）（P〈0.05）. Compared with before treatment,the positive rate of APLA（21.6%,16/74）and AIA（21.6%,16/74）increased significantly（P〈0.05）in LIT group.The cumulative positive rate of APLA（36.5%,27/74）and AIA（33.8%,25/74）was significantly increased in LIT group（P〈0.05）compared with before treatment.Conclusion LIT therapy before pregnancy will improve the successful pregnancy rate in URSA patients.After LIT treatment for 2 times,some patients with AIA or APLA positive should stop LIT treatment,and if none of APLA and AIA turns positive,patients should be carried out another 2 times of LIT treatment.After 4 times of LIT treatment,patients with negative APLA should stop LIT treatment,in order to avoid further autoimmune antibodies turning positive. There is no significant correlation between positive APLA and pregnancy success. Autoimmune antibodies are expected to assist APLA as an effective indicator to monitor the efficacy of LIT and adjust the course of treatment.
作者
侯悦
黄岭
祝雷
张凤悦
李媛媛
陈国庆
孙曙光
乔宠
HOU Yue;HUANG Ling;ZHU Lei;ZHANG Feng-yue;LI Yuan-yuan;CHEN Guo-qing;SUN Shu-guang;QIAO Chong(Shengjing Hospital Affiliated to China Medical University, Shenyang 110004, China)
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2018年第6期635-639,共5页
Chinese Journal of Practical Gynecology and Obstetrics
基金
瘢痕子宫再妊娠预警及分级管理体系的研究(2016YFC1000404)
国家自然科学基金面上项目(81771610)
国家自然科学基金面上项目(81370735)
辽宁省自然基金(201602601)
盛京自由研究者基金(201706)
