不孕不育PPT课件.ppt

,Immunityinfertility,IMMUNOLOGY,免疫性不孕&不育,http:/www.drsonubalhara.in/infertility-doctor-sonu-balhara/,1,.,2019/11/26,CLASSIFICATION,同种免疫,ALLOIMMUNITY,自身免疫,AUTOIMMUNITY,局部免疫,LOCALIMMUNITY,1,2,3,2,.,2019/12/17,01,IMMUNOLOGY,recurrentmiscarriage&Immunologicalacceptance,免疫性习惯流产,3,.,2019/11/26,ProblemswithEmbryoSignalingProblemswiththeMothersImmuneResponsetotheEmbryoThrombophilia:BloodClottingIssue,2%ofwomenofreproductiveageexperiencehabitualmiscarriage.,ProblemswithEmbryoSignalingOnceconceptionhastakenplacethedevelopingembryomustsignalthemothersimmunecellstorecognizeitas“self”ratherthanaforeigninvader.TheembryodoesthisbysecretingHLAGantigentosignalthemothersimmunecellstoallowittogrowandstay.InthiscaseHLAGantigenimproperlyfunctionsandthemothersimmunecellsattacktheembryo,eventuallyresultinginmiscarriage.ThisisconsideredaHLAGgenemutation.,http:/natural-fertility-,4,.,2019/12/17,ProblemswithEmbryoSignalingProblemswiththeMothersImmuneResponsetotheEmbryoThrombophilia:BloodClottingIssue,2%ofwomenofreproductiveageexperiencehabitualmiscarriage.,ProblemswithEmbryoSignaling,5,.,2019/12/17,ProblemswithEmbryoSignalingProblemswiththeMothersImmuneResponsetotheEmbryoThrombophilia:BloodClottingIssue,2%ofwomenofreproductiveageexperiencehabitualmiscarriage.,ProblemswiththeMothersImmuneResponsetotheEmbryoThisiswhenthemothersimmunecellsdonotrespondtothehealthysignalofHLAGantigenrelease.Again,themothersimmunecellsattacktheembryo.Whenanembryoisattackeditisnotdestroyed,butcausesinactivationoftheDNAintheembryosothatthesecellsstopdividingandreplicating.Theembryofailstogrowanddies.,http:/natural-fertility-,6,.,2019/12/17,ProblemswithEmbryoSignalingProblemswiththeMothersImmuneResponsetotheEmbryoThrombophilia:BloodClottingIssue,2%ofwomenofreproductiveageexperiencehabitualmiscarriage.,Thrombophilia:BloodClottingIssueThishappensafterthemothersbodyrecognizesthebabyaspartofherselfandtheembryohasimplanted.Thevesselsintheplacentatakebloodandnutrientstothefetus.Inthecaseofabloodclottingissuerelatedimmunologicalmiscarriage,thosevesselsclotoff,literallystarvingtheembryoofoxygen,blood,andvitalnutrients.,http:/natural-fertility-,7,.,2019/12/17,02,IMMUNOLOGY,anti-spermantibodies,抗精子抗体,8,.,2019/11/26,WHO将不孕不育定义为性活跃期的夫妇未采用任何避孕措施，备孕1年而未能成功受孕的现象。不孕不育的发生率越来越高，已成为影响夫妻双方身心健康，干扰个人生活质量的世界卫生问题。2009年，全球不孕不育的患病例数为五千万八千万，我国育龄人群不孕不育发病率约为10%15%，约10%30%的不孕不育与抗精子抗体(antispermantibody，AsAb)的存在相关。,9,.,2019/12/17,病因,正常：女性生殖道内存在完整的局部免疫防御机制，进入女性生殖道的精子虽然为同种异体抗原，但精浆中存在一种强效免疫抑制剂，这些物质牢固地吸附在精子的表面，抑制了女性生殖道对精子抗原的免疫攻击，正常女性生殖道不会产生AsAb。异常：女性生殖道损伤，月经期性生活免疫抑制丢失：女性生殖道局部免疫系统的调节作用，男性精液含有TGF-及前列腺素E等一系列免疫抑制因子生殖道感染：阴道炎、宫颈糜烂等生殖道感染,可导致黏膜受损（解脲支原体，衣原体，幽门螺杆菌(H.pylori)）男方精液中白细胞增加与女方生殖道局部和血清中AsAb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。,10,.,2019/12/17,抗精子抗体干扰生殖过程的机制,1.抑制精子的运动活力：具有使活动精子凝集和制动的作用,且这一作用与AsAb浓度成正相关。AsAb可影响精子的形态和活力，且被AsAb束缚的精子比率与精子受精能力相关。结合于精子头部的AsAb可影响顶体反应,引起免疫性不孕,而结合于精子干部的抗体能抑制精子运动,引起精子活力下降或死亡,这种作用可能与AsAb的细胞毒效应有关。,11,.,2019/12/17,2.抑制精子穿透宫颈黏液：精子的“颤动现象”（shakingphenomenon）；精子暴露于宫颈黏液或宫颈管的AsAb中,会引起补体激活,导致精子膜受损,以致不活动或死亡。,12,.,2019/12/17,3.干扰精子获能及顶体反应4.影响精子穿透ZP及精、卵结合,13,.,2019/12/17,治疗中医文化的博大精深,西医治疗方法:避孕套避孕、免疫抑制剂干预、精子洗涤后宫腔内人工授精等贵且疗效有限中医