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目的观察主动免疫治疗不明原因习惯性流产的疗效。方法对33例不明原因习惯性流产患者采取主动免疫治疗,观察治疗效果,比较治疗前后外周血免疫相关指标变化以及该变化与疗效的相关性。结果 (1)共妊娠23例(69.7%),其中已足月分娩10例(30.3%),早产3例(9%),目前尚在妊娠中8例(24.2%),再次自然流产2例(6%);未受孕10例(30.3%)。(2)治疗后免疫球蛋白IgG、IgM水平较治疗前明显下降(P<0.05),补体C3、CD4亦有下降趋势(均P<0.05)。(3)在治疗成功组,IgG、IgM、C3、CD4/CD8水平于治疗后明显下降(均P<0.05),而治疗失败、不孕组治疗前后各指标变化差异无统计学意义(P>0.05)。(4)对免疫治疗结局有影响的指标为IgM、C4、CD3、CD8、ACA阳性和流产次数;治疗前C4越高、CD8越低、流产次数越多以及ACA阳性者,越容易导致治疗失败。结论主动免疫治疗是治疗不明原因性习惯性流产的有效方法 ;治疗后免疫球蛋白、补体以及T淋巴细胞亚群比例均朝有利于妊娠的方向发展;治疗前的有关指标可以预示治疗结局,有利于指导临床治疗选择。
Objective To observe the effect of active immunotherapy in treating unexplained habitual abortion. Methods 33 cases of unexplained habitual abortion patients take active immunotherapy to observe the effect of treatment, compared with before and after treatment of peripheral blood immune-related indicators and the relationship between the changes and efficacy. Results (1) Totally 23 cases (69.7%) were pregnant, including 10 cases (30.3%) of full-term delivery, 3 cases of premature delivery (9%), 8 cases of pregnancy (24.2%), 2 cases of spontaneous abortion (6%); 10 cases without conception (30.3%). (2) After treatment, the levels of immunoglobulin IgG and IgM decreased significantly (P <0.05) and the levels of complement C3 and CD4 decreased (all P <0.05). (3) In the successful treatment group, the levels of IgG, IgM, C3 and CD4 / CD8 were significantly decreased after treatment (all P <0.05), while the treatment failed. There was no significant difference in the indexes before and after treatment in the infertility group (P> 0.05). (4) IgM, C4, CD3, CD8, ACA positive and miscarriage times were all the indicators of immunotherapy outcomes. The higher the pretreatment C4, the lower the CD8, the more the miscarriage and the more ACA were, the easier the treatment failed . Conclusions Active immunotherapy is an effective method to treat unexplained habitual abortion. After treatment, the proportion of immunoglobulin, complement and T lymphocyte subsets are all favorable to the development of pregnancy. The relevant indexes before treatment can predict the outcome of treatment. There are Will help guide the choice of clinical treatment.