Infected, Genetics And Immunologic Factors Of Patients With The History Of Abnormal Pregnancy History

BACKGROUND Recurrent spontaneous abortion is defined as three or more consecutive spontaneous pregnancy losses.It accounts for 0.4% to 1.0% of the total spontaneous pregnancy losses (15%-20%).The etiological factors are very complicated and diverse. Currently, known factors include: genetic abnormal lities, endocrine disorders, infections, immunological factors and uterine anomalies.OBJECTIVE To study the relationship between genetic factors, immune factors, infection factors and recurrent spontaneous abortion.METHODS The study was carried out from April 2000 to May 2007 at Jilin University First clinical hospital, specific diseases Detection Station at School of Basic Medical Sciences, Jilin University. Institute of Reproductive Medicine,Jilin province.A total of 657 patients with the history of abnormal pregnancy were evaluated .The control group consisted of 30 healthy,fertile female volunteers with proven fertility.Following tests were performed to evaluate the causes:Peripheral blood for karyotype analysis,in serum ACA-IgG, ANA-IgG, EmAb-IgG, AsAb-IgG ,AovAb-IgG for immunologic- al studies.For infections,Ureaplasma urealyticum(UU)was cultured and Enzyme immunoassay for Chlamydia trachomatis(CT)from cervical mucus was done. Screening for TORCH(Toxoplasma,Rubella , Cytomegalovirus , Herpes Simplex I&II)in serum was performed for specificantibody.Statistical analysis was performed usingχ~2 test.P<0.05 was considered to be statistically significant.Results 1. Of all 657patients with RSA, In tests for infection, for female patients, UU tested positive in 16.29%(107/657), CT tested positive in 11.57%(76/657) and coinfection of UU and CT in 8.22%(54/657).The percentage of positive tests for UU, CT and (UU+CT) were significantly higher in the study group than that in the control group (P<0.01). 2. Of all 657 patients with RSA, In tests for infection, For male patients, UU tested positive in 8.83%(58/657), CT tested positive in 4.72%(31/657) and coinfection of UU and CT in 2.59%(17/657).The percentage of positive tests for UU, CT and (UU+CT) were significantly higher in the study group than that in the control group (P<0.01). 3. Of all 657 patients with RSA, In tests for infection ,For couples, both positive infections were detected:UU(+)46 cases,CT(+)24 cases, (UU+CT)(+)13 cases. The percentage of positive tests for UU, CT and (UU+CT) were signifycantly higher in the study group than that in the control group (P<0.01).4.Tests for TORCH were positive in 12.33% (81/657). Among these, Cytomegalovirus tested positive in 34.57% (28/81), Rubella tested positive in 41.98% (34/81), and 5.18% (34/657) of total TORCH percentage. Toxoplasma gondii tested positive in 9.88% (8/81), and 1.22% (8/657) of total TORCH percentage. Herpes Simplex were positive in 13.58% (11/81), giving a total percenttage of 1.67% (11/657). 5. Of all 467 patients with the history of abnormal pregnancy, chromosome abnormalities were identifyed in 4.06% (19/467).6. In 19 abnormal karyotypes, the rate of chromosome abnormal karyotypes was 36.84% (7/19) .The detection rate was 1.50% .Among these, balance translocation 4 cases ( Including 1 case robertsonian translocation, Mutual translocation 3 cases) giving a abnormalkaryotypes percent of 21.05% (4/19), and 0.86% detected rate. Syndrome X3 1 case, chimerism 2 cases. Chromosome polymorphism 12 cases, accounting for 63.16% of the total anomalies, and the detection rate was 2.57%. Which accounted for the highest rate of abnormal karyotype is the Secondary constriction of the 5 cases for the extension of 26.32% and the detection rate was 1.07%. This was followed by the arm of chromosome 9 pericentric inversion 4 cases of abnormal karyotype of 21.05% and the detection rate was 0.86%. One case of D, G variation of the group, one case of big Y, one case of Yp+.7. Of all 19 patients with the history of abnormal pregnancy, the types of chromosomal abnormalities include: 46,XY,t(10;22)(q25;q13),46,XX,t(2;6)(q21;q25),46,XY,t(3;15)(p13;q22),45,XX,-13,-14,+t(13;14)(q10;q10),46,XX[7]/46,XX,inv(9)(p11q12)[8],47,XXX,46,XY/46,XY,t(1::19),46,XY,inv(9),46,XY,inv(9)(p11q13),46,XX,inv(9)(p11q13),46,XY,inv(9)(p11q12),46,XY(21pss),46,XX,1(q12+),46,XY,1(q12+),46,XY,1(q12+),46,XY,1(q12+),46,XY,1(q12+),46,XY(y>18),46,XY,Yp+. 8. AsAb-IgG tested positive in 36.54%(72/197), EmAb-IgG in 34.38%(33/129), and ACA-IgG in 26.55% (47/177),AovAb-IgG in 18.42%(14/76), ANA-IgG in 7.35%(5/68), This data was significantly higher than that of the controlgroup(P<0.01).CONCLUSIONS UU, CT infection and coinfection could lead to RSA. Male UU, CT infection can not be ignored. Virus infection may be associated with the RSA. Chromosome abnormalities can lead to RSA, including chromosome translocations, inversions and the abnormal number of chromosome. ACA, ANA, EmAb, AsAb, AovAb positive, and other immune factors are relevated with RSA, among these, the most closest relationship with RSA was ACA .