반복적 태아 손실이 있는 부부에서의 주 조직 적합성 = major Histocompatibility in Couples with Recurrent Pregnancy Loss

다국어 초록 (Multilingual Abstract)

The survival or loss of the fetus as an allograft remains a significant immunological problem. Although chromosomal abnormality has been known as the major cause in spontaneous abortion, immunologic factors have recently been reported as the major cause in recurrent pregnancy loss(RPL). Many studies have supported the association between HLA antigens and RPL, but other studies could not confirm this finding. The purpoe of this study is to clarify these conflicting results and determine the new criteria of immunotherapy in couples with RPL due to immunologic causes. To clarify the relationship between HLA antigens and RPL, incidence of hla antigens, homozygosity, degree of disparity and incidence of sharing from 25 couples experiencing RPL were compared with those of 51 randomized fertile couples as a control group. issue typing was performed using a standard microlymphocytotoxictiy test for HLA class I(A,B & C) and a new method of two step polymerase chain reaction(PCR) of DNA samples followed by gel electrophoresis for HLA class II (DRB1, DQA1, DQB1 & DPB1). The results were as follows: 1. In HLA class I antigens, there relatively increased the incidences of Cw3, A2, Cw1, A24 & B22 in RPL group. And compared with the control group, there were significantly more incidences of B17, B61, Cw1 & Cw3. 2. In HLA class II, there relatively increased the incidences of DQB1*01, DQA1*03, DPB1*2, DPB1*05, DQA1*01, DRB1*04, DRB1*06 & DRB1*08 in RPL group. And compared with the control group, there were significantly more incidences of DRB1*08, DQA1*06 & DPB1*13. 3. There were significantly more incidences of homozygosity at the DRB1 & DPB1 loci in RPL group compared with the control group. On the other hand, there were significantly less incidences at the B locus in RPL group. 4. By contrast, the degree of disparity significantly decreased at the DRB1 & DPB1 loci and significantly increased at the B locus in RPL group compared with the control group. 5. Incidence at individual locus significanly increased only at the C locus in RPL group compared with the control group. But all of the remaining loci tended to increase relatively in RPL group. 6. incidence of couples with HLA alleles shared four or more was significantly increased in RPL group compared with the control group. And incidence of couples shared five or more was also significantly increased in RPL group. But incidence of couples with HLA alleles shared three or more was not significantly different between two groups. The findings of this study suggest that it seems to me relatively close association between RPL and HLA, especially class II rather than class I, and that immunotherapy must be done in case of HLA alleles shared four or more in each couple.