复发性流产与反复种植失败相关危险因素比较

摘要

目的 探讨复发性流产(RM)与反复种植失败(RIF)相关危险因素的联系与差异,为临床诊治提供依据.方法 2010年1月至2011年10月在南方医科大学南方医院生殖中心,选取RM患者68例及RIF患者22例进行男女双方染色体及女方的子宫解剖、内分泌、凝血、免疫共五方面筛查,比较两组基线资料及各方面异常率.结果 RM组免疫异常率及NK细胞异常率均显著高于RIF组(分别为94.1％ vs.72.7％及84.4％ vs.57.1％,x2=5.687及x2=5.278,P均＜0.05)；两组男方染色体异常率均高于女方,RM组双方染色体异常率分别为16.2％ vs.5.9％(P＞0.05),RIF组为36.4％vs.4.5％(x2=3.387,P＜0.05).两组相关危险因素混合异常率(≥2项)分别为86.8％vs.77.3％(P＞0.05),以高凝状态(86.8％vs.86.4％)及免疫异常(94.1％vs.72.7％)为主,其检测指标以狼疮抗凝物(LA)异常(58.2％ vs.70.0％)及NK细胞异常(84.4％ vs.57.1％)为主.结论 RM及RIF的相关危险因素均包括遗传、子宫解剖、内分泌、凝血、免疫五方面,且多为混合异常,均以凝血及免疫异常为主,而RM可能与外周血NK细胞增高更密切；此外,男方染色体异常比女方染色体异常与不良妊娠结局可能更相关.%Objective To investigate the connections and differences in risk factors between recurrent miscarriages (RM) and repeated implantation failure (RIF), which will provide the basis for clinical diagnosis and treatments. Methods Abnormalities in parental chromosomes, uterus anatomy, endocrine, coagulation and immunity were screened in 68 cases diagnosed as RM and 22 cases as RIF from Center of Reproductive Medicine in Nanfang Hospital. T and x2 test was applied in comparison of the abnormal rates in each aspect. Results The rate of immune and NK cells abnormalities in RM were significantly higher than in RIF(94.1% versus 72.7% and 84.4% versus 57. 1% ,X2 =5. 687 and X2 =5. 278,respectively ,P<0.05). Male chromosome abnormalities were more than female in both groups, 16.2% versus 5.9% (P > 0.05)in RM group and 36.4% veraus4.5% (X2 =3.378 ,P <0.05) in RIF group. The abnormal rale of combined risk factors( ≥2 aspects) in two groups were 86. 8% versus 77. 3% (P > 0.05), mainly in thrombophilia (86. 8% versus 86.4%) and immune abnormalities (94.1% versus 72.7%), in which lupus anticoagulant ( LA) (58.2% versus 70.0% )and NK cells abnormalities(84.4% versus 57. 1% ) were the most important. Conclusion Both RM and RIF are related with risk factors for five aspects including heredity,uterus anatomy,endocrine,coagulation and immunity,which are mostly mixed abnormalities,maily in coagulation and immunity;whereas RM may be more related to increased peripheral blood NK cells. In addition,male chromosome abnormality perhaps contribute more to poor pregnancy outcome than female.