免疫调控在子痫前期早期干预中的作用和评价

doi:10.7504/fk2014090113

摘要/Abstract

摘要：

子痫前期的发生与免疫失调有一定的关系。母胎界面免疫耐受异常使滋养细胞侵袭性下降，子宫螺旋小动脉的“重铸障碍”，导致病理性胎盘形成；自身免疫异常如抗磷脂抗体通过干扰依赖磷脂的各种凝血与抗凝血因子的功能，使凝血功能紊乱，胎盘微血栓形成，导致胎盘灌注量的下降。子痫前期的早期干预措施包括：对于有子痫前期高危因素的孕妇妊娠中期开始服用小剂量阿司匹林，有较好的预防作用；妊娠早期和中期应用低分子肝素治疗也有一定的疗效；各种免疫治疗和抗氧化治疗的效果缺乏循证医学证据。

关键词: 子痫前期, 自身免疫, 免疫耐受, 早期干预

Abstract:

Abstract: The occurrence of preeclampsia and immune disorders have certain relations. Abnormal immune tolerance of maternal-fetal interface makes invasive trophoblast cells decrease and uterine spiral arteries of "recast obstacles"occur, leading to the formation of pathological placenta.There are various autoimmune abnormalities,for example,antiphospholipid antibody interferes with blood clotting and anticlotting factors,resulting in clotting disorders and placental micro thrombosis,which leads to decreased placental perfusion volume.Preeclampsia early intervention measures include:with risk factors,for pre-edampsia for pregnant women start taking low-dose aspirin in the middle trimester,which has a better preventive effect. During early and metaphase trimester of pregnancy,low-molecular weight heparin therapy also has a certain effect.The effect of various immune treatment and oxidation treatment lack evidence of evidence-based medicine.

Key words: preeclampsia, autoimmunity, immune tolerance, early intervention

中图分类号:

R714.24+4

范玉芹1，李磊2，王谢桐1，2. 免疫调控在子痫前期早期干预中的作用和评价[J]. 中国实用妇科与产科杂志, DOI: 10.7504/fk2014090113.

FAN Yu-qin,LI Lei,WANG Xie-tong.. Role of immune regulation in the early intervention of preeclampsia and its evaluation.[J]. Acta Metallurgica Sinica, DOI: 10.7504/fk2014090113.

参考文献

［1］   Vitoratos N, Vrachnis N, Iavazzo C,et al. Preeclampsia: molecular mechanisms, predisposition, and treatment［J］. Pregnancy,2012，145：487-491.

［2］   Perez-Sepulveda A, Torres MJ, Khoury M,et al. Innate immune system and preeclampsia［J］.Front Immunol，2014,5:244-249.

［3］   Perricone C, de Carolis C, Perricone R. Pregnancy and autoimmunity: a common problem［J］. Best Pract Res Clin Rheumatol, 2012, 26(1):47-60.

［4］   Perez-Sepulveda A, Torres MJ, Khoury M. et al. Innate immune system and preeclampsia.［J］. Front Immunol,2014,26(5):244-251.

［5］   Shankarkumar U, Shankarkumar A, Chedda Z,et al. Role of 14-bp deletion/insertion polymorphism in exon 8 of the HLA-G gene in recurrent spontaneous abortion patients ［J］. Hum Repord Sci,2011,4(3):143-146.

［6］   Olayemi O, Strobino D, Aimakhu C, et al. Influence of duration of sexual cohabitation on the risk of hypertension in nulliparous parturients in Ibadan: a cohort study ［J］. Aust N Z J Obstet Gynaecol,2010,50 (1) : 40- 44.

［7］   Canti VM,Castiglioni T,Rosa S,et al. Pregnancy outcomes in patients with systemic autoimmunity［J］. Autoimmunity,2012,45(2):169-175.

［8］   Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking:systematic review of controlled studies［J］. BMJ,2005，330:565-569.

［9］   Dreyfus M, Hedelin G, Kutnahorsky R,et al.Antiphospholipid antibodies and preeclampsia: a case-control study［J］.Obstet Gynecol,2001,97(1):29-34.

［10］   Cowchock FS, Reece EA, Balaban D, et al. Repeated fetal losses associated with antiphospholipid antibodies: a collaborative randomized trial comparing prednisone with low-dose heparin treatment［J］. Am J Obstet Gynecol,1992,166:1318-1323.

［11］   Triolo G, Ferrante A ,Accardo-Palumbo A, et al. IVIG in APS pregnancy［J］.Lupus,2004,13(9):731-735.

［12］   Visintin C, Mugglestone MA, Almerie MQ, et al. Management of hypertensive disorders during pregnancy：summary of NICE guidance ［J］. BMJ,2010,341：c2207.

［13］ Redman CW. Hypertension in pregnancy: the NICE guidelines［J］. Heart,2011,97( 23) :1967-1969.

［14］   Schramm AM, Clowse ME. Aspirin for prevention of preeclampsia in lupus pregnancy［J］.Autoimm Dis,2014,2014:920467.

［15］   Baneriee S, Jeyaseelan S, Gulena R. Trial of lycopene to prevent preeclampsia in healthy primigravidas: results show some adverse effects［J］. Obstet Gynaecol Res,2009,35(3):477-482.

［16］    Salles AM, Galvao TF, Silva MT, et al. Antioxidants for preventing preeclampsia; a systematic review［J］.Sci Wor1d,2012,2013:243476

［17］   Ota K, Dambaeva S, Han AR, et al. Vitamin D deficiency may be a risk factor for recurrent pregnancy losses by increasing cellular immunity and autoimmunity［J］. Hum Reprod,2014,29(2):208-219.

［18］   Bodnar LM ,Krohn MA, Simhan HN. Maternal vitamin D deficiency is associated with bacterial vaginosis in the first trimester of pregnacy ［J］. J Nutr,2009,139(6):1157-1161.

                                   （2014-08-28收稿）

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