An update in recurrent spontaneous abortion
An update in recurrent spontaneous abortion
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DOI：
10.1007/s00404-004-0706-y
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发表时间：
2005-07-01
影响因子：
2.6
通讯作者：
Agrawal, Suraksha
中科院分区：
文献类型：
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作者：
Pandey, Manoj Kumar;Rani, Reena;Agrawal, Suraksha
复发性自然流产 (RSA) 定义为妊娠 20 周之前连续 3 次或以上妊娠流产。复发性自然流产的病因通常不清楚，可能是多因素的，在诊断和治疗方面存在很多争议。合理接受的病因包括遗传、解剖学、内分泌、胎盘异常、激素问题、感染、吸烟和饮酒、暴露于环境因素、心理创伤和应激生活事件、某些凝血和免疫调节蛋白缺陷。检测到任何这些区域的异常都可能导致采取特定的治疗措施，并取得不同程度的成功。然而，大多数 RSA 病例仍然无法解释，并被发现与某些自身免疫（APA、ANA、ACA、ATA、AECA）和同种免疫（APCA、Ab2、MLR-Bf）抗体有关，这些抗体可能在妊娠免疫失败中发挥重要作用，并可能导致流产。 HLA-G 分子表达、细胞因子 T 辅助细胞 1 (Th-1) 模式和自然杀伤 (NK) 细胞活性的改变也可能导致流产。各种形式的治疗，如阿司匹林和肝素等抗血栓治疗、静脉注射免疫球蛋白 (IVIg) 治疗、父体淋巴细胞免疫治疗和维生素 D3 治疗，是治疗 RSA 女性不明原因流产的有效方法。
Recurrent spontaneous abortion (RSA) is defined as three or more consecutive pregnancy losses prior to the 20th week of gestation. The etiology of recurrent spontaneous abortion is often unclear and may be multifactorial, with much controversy regarding diagnosis and treatment. Reasonably accepted etiologic causes include, genetics, anatomical, endocrine, placental anomalies, hormonal problems, infection, smoking and alcohol consumption, exposure to environmental factors, psychological trauma and stressful life event, certain coagulation and immunoregulatory protein defects. Detection of an abnormality in any of these areas may result into specific therapeutic measures, with varying degrees of success. However, the majority of cases of RSA remains unexplained and is found to be associated with certain autoimmune (APA, ANA, ACA, ATA, AECA) and alloimmune (APCA, Ab2, MLR-Bf) antibodies that may play major role in the immunologic failure of pregnancy and may lead to abortion. Alteration in the expression of HLA-G molecules, T-helper-1 (Th-1) pattern of cytokines and natural killer (NK) cells activity may also induce abortion. Various forms of treatment like antithrombotic therapies such as aspirin and heparin, intravenous immunoglobulin (IVIg) therapy, immunotherapy with paternal lymphocytes and vitamin D3 therapy are effective mode of treatment for unexplained cause of fetal loss in women with RSA.