中国妇幼保健

目的探讨复发性流产(recurrent spontaneous abortion,RSA)的病因及免疫治疗后妊娠结局,为RSA的诊断和防治提供临床依据。方法分析2013年1月~2013年12月在厦门市妇幼保健院计划生育科就诊的263对早期RSA患者病因,并对108例封闭抗体阴性同种免疫型RSA患者进行免疫治疗,分析免疫治疗后怀孕的妊娠结局;对免疫治疗后仍发生自然流产的患者行绒毛染色体检查。结果 263例复发性流产患者中,44例反复自然流产前曾行人工流产16.7%(44/263);151例(57.4%,151/263)RSA患者存在解剖、内分泌、感染、遗传、免疫和血栓前状态等相关病因,其中16例(6.1%,16/263)封闭抗体阳性,部分患者存在2种以上相关病因;112例(42.6%,112/263)患者未发现上述相关病因,但此112例患者均为封闭抗体阴性。接受免疫治疗的108例封闭抗体阴性(同种免疫异常)患者中,98人封闭抗体转为阳性,阳转率为90.7%。接受随访的107例患者中,28例足月分娩、52例孕12周以上,成功率为74.8%(80/107,以妊娠大于12周认为成功)。12例经主动免疫治疗后仍发生自然流产的患者绒毛染色体异常发生率41.7%(5/12)。结论人工流产是导致复发性流产的风险因素之一,复发性流产治疗前有必要进行系统和全面的病因筛查,同种免疫异常患者行免疫治疗可以改善复发性流产患者的妊娠结局;胚胎染色体异常是引起复发性流产的一个重要原因。

Objective To explore the causes of recurrent spontaneous abortion( RSA) and pregnancy outcomes after immunotherapy,provide a clinical basis for diagnosis,prevention,and treatment of RSA. Methods The causes of RSA among 263 couples from Department of Family Planning in the hospital from January to December in 2013 were analyzed,108 RSA patients with abnormal iso-immunization and negative blocking antibody were treated by immunotherapy; the pregnancy outcomes after immunotherapy were analyzed; chorionic villi chromosomal examination was conducted among the patients with RSA after immunotherapy. Results Among 263 RSA patients,44 cases( 16. 7%) had artificial abortion history before RSA; 151 cases( 57. 4%) had anatomic,endocrinologic,infection,genetic,immune,and prethrombotic state related causes,16 cases( 6. 1%) had positive blocking antibody,partial cases had more than two kinds of causes; 112cases( 42. 6%) had no above-mentioned causes,but these cases had negative blocking antibody. Among 108 cases treated by immunotherapy,blocking antibody of 98 cases converted to positive,the rate was 90. 7%. Among 107 cases followed up,28 cases got full-term pregnancy,52 cases got pregnancy for more than 12 gestational weeks,the successful rate was 74. 8%. Among 12 cases with RSA after immunotherapy,the incidence rate of chorionic villi chromosomal abnormalities was 41. 7%( 5 /12). Conclusion Induced abortion is one of the risk factors for RSA,systematically and comprehensive etiological screening is necessary before treatment of RSA,immunotherapy can improve pregnancy outcome of RSA with abnormal iso-immunization; fetal chromosomal abnormality is a major reason of RSA.