静脉注射免疫球蛋白在患者中使用,患者有不明原因的重复性妊娠损失
Shorooq Banjar1,2, Einav Kadour3,4, Rabea Khoudja2
1Division of Clinical Immunology and Allergy, Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
静脉注射免疫球蛋白 (IVIg) 可以改善初级复发性流产 (RPL) 的妇女的活产率,特别是那些先前流产多次的妇女. 仔细选择患者是有效使用IVIg在RPL治疗的关键.
科学领域:
- 生殖免疫学 生殖免疫学
- 免疫调节疗法 免疫调节疗法
背景情况:
- 复发性流产 (RPL) 影响高达4%的夫妇,超过50%的病例仍然无法解释.
- 免疫系统在成功怀孕中起着至关重要的作用,这表明RPL中的免疫媒介因素.
- 静脉注射免疫球蛋白 (IVIg) 是一个有争议的免疫调节治疗RPL由于缺乏确定的疗效和治疗方案.
研究的目的:
- 在一个中心评估IVIg治疗无法解释的RPL的6年结果.
- 为在选定的RPL患者群体中适当使用IVIg制定框架.
- 为了比较IVIg治疗患者和自然史队列之间的活产率和安全结果.
主要方法:
- 以IVIg (n=169) 治疗未解释的RPL患者的回顾性单中心队列研究.
- 纳入标准:母亲年龄<42,BMI<35,非吸烟者,尽管接受标准治疗,但至少连续3次RPL.
- 结果与自然史队列 (没有IVIg) 相比;主要结果是活产率 (LBR).
主要成果:
- 在具有≥5次先前损失的初级RPL患者中,IVIg与显著更高的LBR相关 (66.7%与18.8%,p=0.0113).
- 回归分析表明IVIg对初级RPL活产的潜在益处 (OR=3.27,p=0.03).
- 在二次RPL患者中,IVIg没有改善LBR (33.3%对47%,p=0.495);没有报告严重不良事件.
结论:
- 对于RPL患者的特定亚组,IVIg可能是有效的治疗方法,特别是那些患有高阶初级RPL且其他治疗方法失败的患者.
- 需要进一步的研究来阐明免疫介导的RPL和IVIg的作用模式的机制.
- 建议为选择明确的患者组进行IVIg治疗提供一个框架,以优化IVIg的使用并减轻短缺问题.
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