妊娠期胎儿绒毛外滋养层细胞(extravillous trophoblasts,EVTSs)侵入母体子宫蜕膜组织.然而,母体免疫系统识别半基因不合的胎儿并支持其在体内发育的现象与经典的免疫排斥理论相悖.母体免疫系统对非自体胎儿建立免疫耐受的同时还需要抵御感染,因此需要母胎微环境高度协调以促进成功妊娠.而复发性自然流产(recur-rent spontaneous abortion,RSA)、子痫前期(preeclampsia,PE)和感染等发生不良妊娠结局的风险较高,研究表明这与母胎界面免疫微环境失衡密切相关.本综述主要介绍了妊娠早期母胎界面免疫微环境,尤其是当前对蜕膜NK(decidua NK cell,dNK)细胞的功能认识.此外,也讨论了 RSA,PE和感染状态下,母胎界面免疫微环境改变,尤其是dNK细胞变化,对妊娠结局的影响.旨在总结和进一步认识正常和异常妊娠过程中的母胎界面免疫微环境变化,为妊娠疾病的治疗提供理论依据.
Immune microenvironment at the maternal-fetal interface in early pregnancy and pregnancy-related diseases
Fetal extravillous trophoblasts invade maternal decidual tissue during pregnancy.However,the maternal immune system recognizes the semi-allogeneic fetus and supports its growth and development in utero,which contradicts the classical theory of immune rejection.The maternal immune system must establish tolerance to the allogeneic fetus while maintaining the ability to defend against pathogens.Such tolerance requires the establishment of a well-coordinated maternal immune system to promote a successful pregnancy.In contrast,a high risk of adverse pregnancy outcomes has been shown in patients suffering from recurrent spontaneous abortion(RSA),preeclampsia(PE),or infection.This high risk of adverse pregnancy outcomes is closely related to immunological imbalance at the maternal-fetal interface.In this review,we illustrate the immune microenvironment at the maternal-fetal interface in early pregnancy,especially in understanding the function of decidual NK(dNK)cells.We also discuss the impact of an altered immune microenvironment at the maternal-fetal interface on the pregnancy outcome in patients with RSA,PE,or infection,and the effect of dNK cells is highlighted.The aim of this review is to:(ⅰ)summarize and understand the immune microenvironment at the maternal-fetal interface during normal and abnormal pregnancies;(ⅱ)provide a theoretical basis for the treatment of pregnancy-related disorders.
immune microenvironment at the maternal-fetal interfacedecidual NK cellsrecurrent spontaneous abortionpreeclampsiainfection
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维普
