靜脈滴注丙種球蛋白防治復發性流產的臨床效果

黃宇 侯婷婷

[摘要]目的 探討靜脈滴注丙種球蛋白用于復發性流產（RSA）防治的臨床效果。方法 選取2014年9月～2017年12月在我院進行治療的90例RSA患者作為觀察組，按照患者自主意愿選擇靜脈滴注丙種球蛋白治療的46例作為觀察1組，選擇傳統保守治療的44例作為觀察2組，觀察比較兩組的臨床治療效果及不良反應發生情況。同時選擇同期在我院產檢的90名健康女性作為對照組，觀察比較RSA患者與健康女性的丙種球蛋白水平。結果 觀察1組的保胎成功率、足月產率均明顯高于觀察2組（P<0.05），觀察1組的早產兒死亡率、流產率均明顯低于觀察2組（P<0.05）;兩組的不良反應總發生率比較，差異無統計學意義（P>0.05）;觀察組γ-干擾素（IFN-γ）、自然殺傷細胞（NK）水平明顯低于對照組，觀察組白介素-10（IL-10）水平明顯高于對照組，差異均有統計學意義（P<0.05）。結論 RSA患者的丙種球蛋白水平與健康女性存在明顯差異，可作為預防RSA的有效檢測指標。靜脈滴注丙種球蛋白治療RSA可顯著提高保胎成功率及足月產率，且安全性高，具有很高的臨床應用價值。

[關鍵詞]靜脈滴注丙種球蛋白;復發性流產;防治;黃體酮;不良反應

[中圖分類號] R714? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1674-4721（2019）2（a）-0153-03

[Abstract] Objective To explore the clinical effect of Intravenous Gamma Globulin in the prevention and treatment of recurrent abortion （RSA）. Methods A total of 90 patients with RSA who were treated in our hospital from September 2014 to December 2017 were selected as observation group， 46 patients who were treated with Intravenous Gamma Globulin according to their own willingness were selected as observation group 1， 44 patients who chose traditional conservative treatment were selected as observation group 2， and the clinical treatment effects and adverse reactions of the two groups were observed. At the same time， 90 healthy women who did pregnancy check-up in the hospital during the same period were selected as the control group. The level of gamma globulin in patients with RSA and healthy women were observed. Results The success rate of pregnancy and full term yield in the observation group 1 were significantly higher than those in the observation group 2 （P<0.05）. The mortality of premature infant and abortion rate in the observation group 1 were significantly lower than those in the observation group 2 （P<0.05）， and the total incidence of adverse reactions in the two groups was not significantly different （P>0.05） and the level of gamma interferon （IFN-γ） and natural killer （NK） in the observation group were significantly lower than those in the control group （P<0.05）. The level of interleukin-10 （IL-10） in the observation group was significantly higher than that in the control group，the differences were statistically significant （P<0.05）. Conclusion The level of? IFN-γ in RSA patients is significantly different from that in healthy women. It can be used as an effective index to prevent RSA. Intravenous Gamma Globulin in the treatment of RSA can significantly improve the success rate of pregnancy and full term yield， and it has high safety and high clinical value.

[Key words] Intravenous Gamma Globulin; Recurrent abortion; Prevention and treatment; Progesterone; Adverse reactions

復發性流產（RSA）會直接造成胎兒死亡[1]，對孕婦身心造成巨大傷害，還可能破壞患者的家庭和諧，因此RSA的防治工作十分重要。近年來臨床研究表明丙種球蛋白水平在RSA發病過程中出現異常[2]，大部分原因不明的RSA與患者的自身免疫有關，有學者提出丙種球蛋白水平可作為臨床診斷RSA的重要指標之一[3]，而丙種球蛋白靜脈滴注治療是一種被動免疫治療方式，通過向患者體內輸入免疫球蛋白使患者具備免疫保護能力，從而增加了機體免疫力，因此可進一步降低流產率，應用前景廣闊。本研究為進一步觀察靜脈滴注丙種球蛋白在RSA中的防治效果，對46例RSA患者采用靜脈滴注丙種球蛋白治療，并將治療效果與44例采用傳統保守治療的RSA患者進行比較分析，同時觀察比較RSA患者與健康女性的丙種球蛋白水平，現報道如下。……