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复发性流产目前仍是世界难题,有1%~5%的女性面临这个问题[1]。既往定义3次或3次以上20周前的自发流产为复发性流产,目前更多学者[2]认为有2次或2次以上的自然流产病史即可定义为复发性流产。复发性流产的病因复杂,包括遗传因素异常、生殖解剖的畸形、内分泌因素及血栓前状态,另外仍有50%以上的病人属于不明原因的复发性流产(unexplained recurrent spontaneous abortion, uRSA)[3]。大量研究[4-7]发现,这些uRSA病人多有潜在的免疫改变,如细胞免疫异常:子宫NK细胞(uNK)升高、Th1/Th2及Th17/Treg细胞比例失衡,另外还存在其他免疫异常,如抗甲状腺抗体、抗核抗体及抗卵巢抗体的升高等。这些免疫异常可能导致母-胎免疫耐受异常,进一步影响胚胎着床及发育,从而导致流产[3]。由于uRSA的发生与免疫因素密切相关,目前临床常使用免疫治疗,本文就uRSA临床常用的几种免疫治疗的进展作一综述。
不明原因复发性流产的临床免疫治疗进展
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