反复流产的联合治疗.ppt

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1、反复流产的病因反复流产的病因Raghupathy R.Seminars in Immunology 2001;13:219-227.SPONTANEOUS RECURRENT ABORTIONCauses:Explainable(50-60%)geneticinfectiousendocrineautoimmunologic SLE,Anticardiolipin Abs Unexplained(40-50%)allogenic immuneresponse towards paternal antigensR.Raghupathy(1999)Trop I and Levine D.,AJR

2、2001;176:607615抗体（抗体（AB）介导的胚胎毁损或保护介导的胚胎毁损或保护胚胎毒性ABsFabFc封闭封闭ABs(隐匿胚胎抗原)导致流产导致流产胚胎保护胚胎保护 血管自主性截断血管自主性截断 激活激活LAKLAK细胞细胞 凝血因子凝血因子aa 凝血凝血血管炎血管炎胚胎血供胚胎血供Th1:TNF-IL-2 胚胎胚胎保护性免疫调节保护性免疫调节妊娠妊娠期淋巴细胞表面上的期淋巴细胞表面上的P-受体受体Szekeres-Barth J.Int Immunopharm 2001;1:1037.V 1CD56+激活激活V 1CD56+P PP P+(34 kDa蛋白质)normal firs

3、ttrimesterpregnancyVillous trophoblast(50)的的PIBF诱导作用诱导作用Szekeres-Barth J.Gynecological Endocrinology 2001;15(S5):43.尿液中PIBF浓度（ng/ml)Amato NA et al.Minerva Ginecol.2007;59(4):357-67 NO维持胎儿维持胎儿-胎盘低血管阻胎盘低血管阻力状态力状态Mamamtavrishvili I et al.International J Gyn&Obs 2000;70(2):105-105(1)血管一氧化氮分子DHD 增加人脐静脉内皮

4、细胞增加人脐静脉内皮细胞NO合成合成Simoncini T et al.Fertil&Steril 2006;86(3):1235-42浓度依赖时间依赖Arck P.22nd Annual Meeting of the American Society of Reproductive Immunology,2002.Arck P.22nd Annual Meeting of the American Society of Reproductive Immunology,2002.363636.136.136.236.236.336.336.436.436.536.536.636.636.736.736.836.836.936.937371 13 35 57 79 91111131315151717191921212323252527272929313133333535Summary(1)