抗磷脂综合征致复发性流产的免疫炎症血栓机制

doi:10.12280/gjfckx.20251156

摘要/Abstract

摘要：

复发性流产（recurrent spontaneous abortion，RSA）的病因复杂多样，其中免疫性疾病抗磷脂综合征（antiphospholipid syndrome，APS）作为血栓形成的高危因素，主要通过免疫炎症血栓机制导致不良妊娠结局的发生。APS主要通过抗磷脂抗体（antiphospholipid antibody，aPL）启动免疫炎症血栓级联反应，即蜕膜自然杀伤细胞、蜕膜巨噬细胞及调节性T细胞功能失衡，肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）、γ干扰素（interferon-γ，IFN-γ）等促炎因子过度释放，损害血管内皮，进而激活Janus激酶（Janus kinase，JAK）-信号转导及转录活化因子（signal transducer and activator of transcription，STAT）、核因子κB（nuclear factor-κB，NF-κB）等信号通路激活补体、损伤血管内皮，促进局部血栓形成，导致母胎界面免疫微环境失衡。因此，基于对免疫炎症血栓病理机制的深入解析，综述APS致RSA的发生机制及临床治疗进展，旨在为未来的研究提供参考，为实施新的诊疗方案提供新的切入点，为药物靶向诊疗RSA合并APS提供理论依据与临床实践参考。

关键词: 流产，习惯性, 抗磷脂综合征, 细胞因子类, 免疫, 血栓炎症

Abstract:

The etiology of recurrent spontaneous abortion (RSA) is complex and diverse. Among them, the immune disease antiphospholipid syndrome (APS), as a high-risk factor for thrombosis, mainly leads to adverse pregnancy outcomes through the immune-inflammatory thrombosis mechanism. APS mainly initiates the immune-inflammatory thrombosis cascade reaction through antiphospholipid antibodies (aPLs). That is, there is a functional imbalance among decidual natural killer cells, decidual macrophages, and regulatory T cells, and an excessive release of pro-inflammatory factors such as tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ), which damage the vascular endothelium. Subsequently, it activates signaling pathways such as Janus kinase (JAK)-signal transducer and activator of transcription (STAT) and nuclear factor-κB (NF-κB), activates the complement system, damages the vascular endothelium, promotes local thrombosis, and leads to an imbalance in the immune microenvironment at the maternal-fetal interface. Therefore, based on the in-depth analysis of the pathological mechanism of immune-inflammatory thrombosis, this paper reviews the occurrence mechanism and clinical treatment progress of RSA caused by APS, aiming to provide reference for future research, a new entry point for implementing new diagnosis and treatment plans, and a theoretical basis and clinical practice reference for targeted drug diagnosis and treatment of RSA complicated with APS.

Key words: Abortion, habitual, Antiphospholipid syndrome, Cytokines, Immunity, Thromboinflammation

赵佳润, 郑舒畅, 王一迪, 王成霞, 何军琴. 抗磷脂综合征致复发性流产的免疫炎症血栓机制[J]. 国际妇产科学杂志, 2026, 53(1): 103-107.

ZHAO Jia-run, ZHENG Shu-chang, WANG Yi-di, WANG Cheng-xia, HE Jun-qin. Immune-Inflammatory Thrombotic Mechanism of Recurrent Spontaneous Abortion Caused by Antiphospholipid Syndrome[J]. Journal of International Obstetrics and Gynecology, 2026, 53(1): 103-107.

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