免疫抑制治疗在复发性流产中的临床应用

doi:10.12280/gjszjk.20260063

摘要/Abstract

摘要：

复发性流产（recurrent spontaneous abortion，RSA）病因复杂，免疫是其发生发展的一种重要因素。免疫异常导致RSA的病理机制包括：以抗磷脂综合征、系统性红斑狼疮为代表的自身免疫性疾病；以母胎免疫排斥为核心的同种免疫异常；以及贯穿于多种病因中的病理性炎症反应。这些因素通过影响胚胎着床、胎盘形成及诱导血栓等途径导致妊娠丢失。各类免疫抑制疗法的临床应用现状与证据如下：①经典免疫抑制剂如糖皮质激素、羟氯喹及钙调磷酸酶抑制剂，仍是治疗自身免疫异常相关RSA的基础，但需严格把握适应证与安全性；②生物靶向药物如肿瘤坏死因子-α抑制剂、白细胞介素抑制剂，为常规治疗失败的难治性病例提供了新的“精准”干预方向，但目前仍处于探索阶段；③免疫球蛋白及外周血单个核细胞疗法等，在特定免疫指标异常的患者中显示出潜力，但疗效尚需更多高级别证据验证。当前免疫抑制治疗虽已从经验性用药走向更具靶向性的阶段，但整体治疗体系仍不健全。未来需借助多组学技术深化机制研究，发掘精准预测疗效的生物标志物，并推进前瞻性随机对照试验，以构建以患者为中心、基于证据的精准免疫抑制治疗新范式，切实改善RSA患者的生殖结局。

关键词: 流产，习惯性, 免疫抑制剂, 免疫疗法, 生物因子, 精准治疗

Abstract:

The etiology of recurrent spontaneous abortion (RSA) is complex, and immune is an important factor of the occurrence and development of RSA. The pathological mechanisms of RSA caused by immune abnormalities include: autoimmune diseases represented by antiphospholipid syndrome and systemic lupus erythematosus; alloimmune abnormalities centered on maternal-fetal immune rejection; and pathological inflammatory responses that run through multiple etiologies. These factors lead to pregnancy loss by affecting embryo implantation, placentation, and inducing thrombosis. The current clinical application status and evidence of various immunosuppressive therapies are as follows: ①Classic immunosuppressants such as glucocorticoids, hydroxychloroquine, and calcineurin inhibitors remain the mainstay for the treatment of RSA associated with autoimmune abnormalities. However, the indication and safety must be strictly controlled. ②Biologic targeted drugs, including tumor necrosis factor-α inhibitors and interleukin inhibitors, provide a new "precision" intervention direction for the refractory cases that fail conventional treatment, although they are still in the exploratory stage. ③Immunoglobulin and peripheral blood mononuclear cell therapy have shown the potential in patients with specific immune abnormalities, but the efficacy requires to be validated by higher-level evidence. Although immunosuppressive therapy has moved from empirical use to a more targeted stage, the overall treatment system remains incomplete. In the future, multi-omics technologies should be employed to deepen the study of mechanism, to discover more biomarkers that accurately predict therapeutic efficacy, and to advance the prospective randomized controlled trials, in order to establish a patient-centered, evidence-based new paradigm of precision immunosuppressive therapy and effectively improve the reproductive outcomes of patients with RSA.

Key words: Abortion, habitual, Immunosuppressive agents, Immunotherapy, Biological factors, Precise treatment

庄国丽, 王滨, 曾健, 田芸, 秦喆. 免疫抑制治疗在复发性流产中的临床应用[J]. 国际生殖健康/计划生育杂志, 2026, 45(4): 347-352.

ZHUANG Guo-li, WANG Bin, ZENG Jian, TIAN Yun, QIN Zhe. Clinical Application of Immunosuppressive Therapy in Recurrent Spontaneous Abortion[J]. Journal of International Reproductive Health/Family Planning, 2026, 45(4): 347-352.

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