母胎界面免疫微环境异常致复发性流产研究进展

doi:10.12280/gjszjk.20220509

摘要/Abstract

摘要：

母体对胚胎识别及免疫耐受的建立是妊娠的必要条件。母胎界面免疫耐受的本质是胚胎滋养层细胞、蜕膜基质细胞和蜕膜免疫细胞共同参与母-胎对话的过程，促进母胎界面免疫微环境的转化及适应性免疫的建立，如滋养层细胞浸润、螺旋动脉重塑和胚胎免疫耐受建立等。母胎界面免疫微环境异常会造成母胎免疫耐受稳态失衡，可能是导致复发性流产（recurrent spontaneous abortion，RSA）的重要原因。母胎界面免疫微环境异常包括母胎界面免疫攻击信号过强、免疫抑制信号不足和免疫微环境紊乱。因此，免疫调节是治疗RSA的核心策略之一，包括免疫抑制剂、免疫调节剂的应用及淋巴细胞主动免疫治疗等，但其疗效需要高级别循证医学证据的验证。

关键词: 母胎界面, 免疫耐受, 免疫微环境, 流产, 习惯性, 免疫调节

Abstract:

Maternal recognition of embryos and the establishment of immune tolerance are necessary conditions for pregnancy. The essence of immune tolerance at the maternal-fetal interface is that embryonic trophoblast cells, decidual stromal cells and decidual immune cells jointly participate in the process of maternal-fetal dialogue, promoting the transformation of the immune microenvironment and the establishment of adaptive immunity at the maternal-fetal interface, such as trophoblast cell infiltration, spiral artery remodeling, maternal-fetal immune tolerance establishment and so on. The imbalanced immune homeostasis caused by abnormal maternal-fetal immune microenvironment is an important cause of recurrent spontaneous abortion (RSA). Abnormal maternal-fetal immune microenvironment includes excessive immune inflammatory response, the impaired immune tolerance, and the oscillation of maternal-fetal immune microenvironment. Therefore, immunomodulation should be one of the core strategies for the treatment of RSA, including the application of immunosuppressants, immunomodulatory drugs, and active lymphocyte immunotherapy. However, the efficacy of immunomodulation needs to be verified by more high-quality evidence from evidence-based medicine.

Key words: Maternal-fetal interface, Immune tolerance, Immune microenviroment, Abortion, habitual, Immunomodulation

苏丹娜, 刁瑞英, 佘加杰, 帅领, 郭艳, 李冬冬, 叶小凤, 汪丽萍. 母胎界面免疫微环境异常致复发性流产研究进展[J]. 国际生殖健康/计划生育杂志, 2023, 42(3): 254-260.

SU Dan-na, DIAO Rui-ying, SHE Jia-jie, SHUAI Ling, GUO Yan, LI Dong-dong, YE Xiao-feng, WANG Li-ping. Research Progress of Recurrent Spontaneous Abortion Caused by Abnormal Immune Microenvironment at the Maternal-Fetal Interface[J]. Journal of International Reproductive Health/Family Planning, 2023, 42(3): 254-260.

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