【摘要】 目的通过检测复发性自然流产(RSA)患者体内封闭抗体(BA)水平来观察淋巴细胞主动免疫治疗(LIT)的效果。方法应用ELISA法检测476例RSA患者治疗前的BA水平,并与120例对照组中孕妇的BA水平相比较,以研究二者BA水平的差异。同时,选择160例BA阴性者用配偶的分离淋巴细胞进行皮内注射主动免疫治疗,治疗后复查BA,并与100例治疗对照组中患者的BA水平比较,以研究BA水平与妊娠结局之间的关系。结果对照组中孕妇的BA阳性率为30.00%,有孕史者明显高于无孕史者,二者之间BA阳性率比较具有明显的差异(P<0.01)。476例RSA患者治疗前BA阳性率为9.24%,其中160例BA阴性者经3次免疫治疗后累计转阳者123例,治疗1~6次后的累计转阳率分别为8.13%、40.63%、76.88%、80.63%、83.13%和84.38%。经治疗后,各组间受孕成功率和成功分娩率差异有统计学意义(P<0.01)。随着治疗次数的增加,累计BA转阳率、累计受孕率和成功分娩率不断上升(P<0.01),而自然流产率有所下降(P<0.01)。治疗次数与累计BA转阳率间有明显的正相关性(r=0.962)。结论无论原发性RSA还是继发性RSA,LIT治疗能提高患者BA阳性率、再次妊娠成功率及成功分娩率。BA水平变化的监测对指导同种免疫性RSA的病因分析、病情监测、治疗手段和受孕最佳时机的选择以及LIT疗效评价等均有十分重要的意义,对预测RSA患者妊娠及再次妊娠的结局均有良好的参考价值。更多还原

【Abstract】 Objective To observe the curative effects of lymphocyte active immunotherapy( LIT) by testing the levels of the patients with recurrent spontaneous abortion( RSA) and blocking antibodies( BA). Methods The ELISA kit was employed to evaluate the BA levels of the 476 RSA patients before the treatment,which were compared with those of 120 pregnant women in the control group,to find out the differences of BA levels between the two groups. At the same time,160 RSA subjects with BA negative reaction were enrolled for active immunotherapy injected subcutaneously with paternal lymphocytes. BA levels would be detected again for the BA negative patients with RSA,compared with those of 100 cases of the subjects from the control group, to probe the relationship between the BA levels and the pregnancy outcomes after LIT. Results The BA positive rate( Pr) of pregnant women in the control group was 30. 0%,that of them with pregnancy history were significantly higher than that of them without history,of which the differences compared between women in both groups existed statistical significance( P < 0. 01). The Pr of BA of 476 RSA patients before treatment were 9. 24%,including 123 in 160 cases turning from negative to positive after immunotherapy after three times of LIT. The cumulative positive rates from one to six times were 8. 13%,40. 63%,76. 88%,80. 63%,83. 13% and 84. 38% respectively. With the increasing number of therapy,the cumulative BA turning Pr was increasing( P < 0. 01),and the cumulative PR and SDR was also increasing,while the spontaneous abortion rate was decreasing( P < 0. 01). Positive correlation existed between the therapy number and the cumulative Pr( r = 0. 962). Conclusion With either primary or secondary RSA,LIT can improve the Pr of BA,SPR and SDR for the patients. BA level monitoring is of great significance in the guidance of etiology analysis,disease monitoring,the choice of treatment means and the best time for conception,the evaluation on LIT effects for alloimmune RSA,which are also of great reference value in predicting pregnancy and repregnancy outcomes for RSA patients.更多还原