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      免疫性不孕症

      【导读】妈妈网网友小珊珊发帖分享了自己备孕三年始终不能好孕的经历,就在前不久小珊珊被确诊为免疫性不孕,这令夫妻二人十分惊讶,原来小珊珊对丈夫的精子产生了抗体,这些抗体直接杀死精子或抑制精子和卵子结合形成受精卵,或者在受精卵形成后,令其无法在子宫内健康成长。那么免疫性不孕有哪些表现?免疫性不孕的类型有哪些?该如何治疗呢?

      免疫性不孕症,是女性不孕症中的常见类型。一般是指患者排卵及生殖道功能正常,无致病因素发现,配偶精液常规检查在正常范围,但有抗生育免疫证据存在,从而造成的不孕症。

      该病的种类很多,但多是由于生殖系统抗原的自身免疫或同种免疫引起。精子、精浆、透明带和卵巢这些生殖系统抗原在特定的情况下均可产生自身免疫或同种免疫,产生相应的抗体,阻碍精子与卵子的结合导致不孕症??咕涌固宓牟褪瞧渲谐<囊恢?。

      因此,免疫性不孕症是一个相对概念,是指免疫使生育力降低,暂时导致不孕。不孕状态能否持续取决于免疫力与生育力间的相互作用,若免疫力强于生育力,则不孕发生,若后者强于前者则妊娠发生。

      夫妻双方保持正常的性生活情况下,任何一方的机体对生殖过程中任一环节产生自发性免疫,导致延迟受孕二年以上,称为免疫性不孕症。免疫性不孕症有广义与狭义之分。广义的免疫性不孕症是指机体对下丘脑-垂体-卵巢(睾丸)轴任一组织抗原产生免疫,女性可表现为无排卵、闭经,男性可表现为精子减少或精子活力降低。通常所指的免疫性不孕症是指狭义的,即不孕夫妇除存在抗精子免疫或抗透明带免疫外,其他方面均正常。

      并非只有妻子对丈夫的精子产生抗体导致不孕,事实上丈夫体内产生对卵子的抗体而导致不孕的情况同样存在。生殖系统的自身抗原在两性均可激发免疫应答,导致自身免疫性不孕症,如男性抗精子免疫性不孕和女性抗透明带免疫不孕。精子抗原还可引起女性同种抗精子免疫反应,称为同种抗精子免疫不孕。已有大量的实验和临床资料证实抗精子抗体可致不孕,在不育患者中约占10%~30%。有关抗透明带抗体的研究则较少,一般认为它可致女性不育,但许多问题尚待证实。

      目前免疫性不孕最为常见的表现形式主要有以下三种,分别是男性抗精子抗体导致的、女性抗精子抗体导致的以及抗精子抗体干预生育环节导致的。

      1、男性抗精子抗体是如何产生的?

      男性自身会出现抗精子抗体吗?这事听起来有些匪夷所思,事实上却非常普遍。精子虽为自身抗原,但它于青春期才出现,被自身免疫系统视为“异己”。然而血睾屏障阻碍了精子抗原与机体免疫系统的接触,不会产生抗精子的免疫反应。若血睾屏障发育不完善或遭到破坏,如手术、外伤、炎症等,导致精子外溢或巨噬细胞进入生殖道吞噬消化精子细胞,其精子抗原激活免疫系统,产生抗精子抗体。

      在了解了手术、外伤和炎症都可能导致男性自身产生抗精子抗体之后,我们需要知道抑制性T淋巴细胞数量减少或活性下降同样会导致这种情况发生。此细胞存在于附睾和输精管的皮下组织中。正常情况下,由睾丸网及共输出管漏出的少量精子抗原可激活抑制性T细胞,使成熟B细胞识别抗原的过程变得迟钝,降低了机体对精子抗原的体液免疫反应,形成免疫耐受。当抑制性T细胞数量或活性下降以及精液内补充抑制性T细胞的因子缺乏时,可产生抗精子抗体。

      2、女性抗精子抗体是如何产生的?

      当女性生殖道出现感染、炎症请情况时,由于感染使局部的非特异性免疫反应加强,这可能导致精子直接被杀死。临床研究表明,男方精液中白细胞增加与女方生殖道局部和血清中抗精子抗体的发生明显相关,提示感染因子作为天然佐剂,免疫相关细胞与精子抗原共同介入女性生殖道,产生同种抗精子免疫。正常精液中含有前列腺素E和一种糖蛋白,具有免疫抑制作用,精液沉淀素具有抗补体活性。这些免疫抑制因素在正常情况下可抑制女方免疫活性细胞针对精子抗原的免疫应答,诱导免疫耐受。若丈夫精液中免疫抑制因子的缺乏可导致女方产生抗精子抗体。

      另外,女性朋友们需要尽量避免在感染和炎症情况下同房,因为在生殖道粘膜破损的情况下性交,可使精子抗原通过破损的粘膜上皮屏障,进入上皮下的B淋巴细胞,产生抗精子抗体。异性间的肛交或口交是女性产生抗精子抗体的原因之一。另外,某些助孕技术如直接腹腔内人工授精,可导致大量精子进入腹腔,被腹腔中的巨噬细胞吞噬后,将精子抗原传递至盆腔淋巴结内的辅助性T淋巴细胞,从而诱发抗精子的免疫反应,使血清中出现暂时的抗精子抗体升高。

      3、抗精子抗体是如何干预生育环节的呢?

      (1)抗精子头部的抗体可干扰精子获能及头粒反应。

      (2)细胞毒抗体在补体参与下使精子细胞膜损伤,精子死亡,抗精子尾干的抗体抑制精子活动。

      (3)抗精子抗体的Fc段与宫颈粘液糖蛋白结合,干扰精子穿过排卵期宫颈粘液。

      (4)抗精子抗体的调理作用增强生殖道局部吞噬细胞对精子的吞噬作用。

      (5)抗精子头部的抗体能阻止精子与透明带及卵细胞膜结合,抑制受精。

      目前,治疗免疫性不孕的方法被常见的包括四种,分别是免疫抑制方法、子宫腔内人工受精、体外受精以及避免抗原接触等。

      1、口服药物干扰巨噬细胞毒作用:这种方法被称为免疫抑制方法。肾上腺皮质激素类药物具有抗炎,干扰巨噬细胞毒作用。因此可用于治疗免疫性不孕症??煽诜〖亮科ぶ世喙檀技に?,抑制免疫反应,如强的松、地塞米松、甲基强的松龙等,一般约需连服3个月以上。

      2、子宫腔内人工受精:当患者宫颈粘液中存在精子抗体干扰生育时,可将其丈夫的精液在体外进行处理,分离出高质量精子行人工受精。此法避免了宫颈黏液中精子抗体对精子通过的限制作用。

      3、使用避孕套等待女方精子抗体呈阴性:此法也被称作是避免抗原接触法。每次性生活时使用避孕套可避免精子抗原对女方的进一步刺激。待女方精子抗体水平下降时,鼓励患者在排卵期去避孕套性生活,或进行人工受精。

      4、体外受精:将精子与卵子在体外培养受精,于受精后3—5天植入宫腔,因此,精子在受精前无需与含有精子抗体的女方生殖道局部接触。受精后,由于孕卵透明带的?;ぷ饔?,使精子抗体不能攻击孕卵,此后孕卵着床。

      【食疗一:煨鹿尾】

      配料干鹿尾100克,蘑菇300克,冬笋50克。

      制法干鹿尾用开水发胀,捞出洗净污秽,再下锅烧10分钟后,捞出煺去毛,不净再烫、再煺,直至净为止,用清水洗净,冷水漂洗30分钟,再次放入锅内,煮沸后改用文火炖熬至熟,待用。将熟鹿尾顺缝剁成短段,蘑菇切成小块,冬笋切成片。将葱、姜片放锅中,炒成金黄色,放入鸡汤、猪油、绍酒、鹿尾、冬笋、白蘑,调味后用中火焖酥,加糖、味精煮至收汁,淋入香油,即成。

      功能温阳益肾,暖宫促孕。本膳用鹿尾,能温阳壮督,填精益髓,暖胞宫,促孕育;蘑菇,含蛋白质和氨基酸;竹笋,有膳食纤维??捎弥闻哟?、腰酸及宫寒所致不孕、不育。

      【食疗二:附杞蒸牛鞭】

      配料附片6克,怀山药20克,枸杞子15克,党参10克,牛鞭2条(约重400克),荔枝肉6克,桂圆肉6克,红枣10枚。

      制法先将荔枝、桂圆、大枣蒸熟,葱切段。附片、党参、山药、杞子,拣去杂质,洗净。牛鞭,先用温水洗净,加水煮2小时,捞出剖开,刮去尿道中白膜和杂质,切开,并剁约45厘米长的段,再切成15厘米条,加适量精盐、醋揉搓,然后置清水中洗净,再放冷水锅中煮至水沸,取出洗去臊味。取去净臊味的牛鞭,放瓷碗内,放入黄酒、葱、生姜、鸡汤、精盐、冰糖,上笼蒸至八成熟,去葱、姜,加附片、党参、山药、杞子及油,再上笼蒸至牛鞭酥烂,撒少些胡椒,即可佐餐食用。

      功能补肾添精,益肝健脾。本膳用附片,温补阳气,暖胞宫以助孕育;淮山药、党参,健脾培中土,以滋后天生化;枸杞子,补肝肾而养血;牛鞭,补充胶蛋白,温阳益髓;桂圆、荔枝、大枣,既能调味,又能补益肝脾气血。故其对于脾肾阳虚,肝肾不足,见腰膝酸软、倦怠乏力诸症的女子的月经失调、婚后不孕育均有作用。

      仙人粥健脾和胃、益肾添精

      【食疗三:仙人粥】

      配料制何首乌30~60克,红枣5~9枚,粳米(或糯米)100克。

      制法先将何首乌加水煎,取浓汁,去渣。粳米、红枣,洗净,入锅中煮成粥时,倾入首乌药汁,再沸,后加适量冰糖,即可食用。

      功能健脾和胃,益肾填精。本膳用首乌,滋肾阴填精血;红枣,健脾调营

      【食疗四:当归生姜羊肉汤】

      配料当归20克,生姜10克,羊肉500克。

      制法将羊肉洗净,切成4厘米见方小块,先用沸水焯一下,以去腥臊。清水500毫升,加当归、生姜,煎取药汁约200毫升,去渣,备用。羊肉,入锅内加水,文火焖煮,肉烂熟,加入药汁,兑匀,并加盐、葱、味精等调味品,稍沸,即可食用。

      功能温阳补血,益肾调经。本膳用当归,养血调;生姜,温中祛寒;羊肉,富含蛋白质,能补下元。故适用于肾阳虚亏,精血不足,月经不调而致的不孕、不育。

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