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静脉注射免疫球蛋白 (IVIg) 在复发性植入失败中使用:是时候进行另一项随机对照试验了吗?

Genevieve Genest¹, Zhiyang Liu², Martine Boivin³

¹Division of Clinical Immunology and Allergy, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada.

Journal of reproductive immunology

|August 24, 2025

概括

复发性植入失败是一种具有挑战性的试管婴儿并发症. 本综述考察了静脉注射免疫球蛋白 (IVIg) 对于RIF的使用,强调需要更好的证据和负责任的处方.

科学领域:

生殖免疫学
在体外受精 (IVF)
免疫调节疗法

背景情况:

复发性植入失败 (RIF) 影响高达5%的试管婴儿患者,超过50%的病例仍然无法解释.
免疫系统失调是RIF的疑似原因, 但缺乏验证的诊断测试, 使其成为排除的诊断.
静脉注射免疫球蛋白 (IVIg) 经常被用于RIF,尽管研究数据异质且不足.

研究的目的:

审查免疫介导的RIF和IVIg的作用的当前知识.
在RIF中讨论IVIg的行动机制.
确定可能受益于免疫调节的患者群体,并倡导IVIg管理.

主要方法:

这篇叙述综合了过去30年关于RIF和IVIg的数据.
它讨论了RIF背后的免疫机制.
它探讨了IVIg作用的潜在机制及其临床应用.

主要成果:

目前对RIF的IVIg的研究往往是异质的,功率不足的,与最近的RIF定义不一致.
对于IVIg对RIF的有效性仍有争议,需要进一步调查.
全球血液制品短缺和IVIg成本上升强调需要仔细审查其使用情况.

结论:

一个精心设计,充足的随机对照试验 (RCT) 对于最终评估IVIg在RIF治疗中的作用至关重要.
在进行RCT之前,对现有数据进行全面分析至关重要.
需要负责任的IVIg管理和具有成本效益的干预措施,特别是考虑到全球使用和价格的增加.

关键词:

免疫介导的复发性植入失败静脉注射免疫球蛋白生殖免疫学无法解释的复发性植入失败

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