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Ebrahimi M, Akbari Asbagh F. The role of autoimmunity in premature ovarian failure. IJRM 2015; 13 (8) :461-472
URL: http://ijrm.ir/article-1-677-fa.html
URL: http://ijrm.ir/article-1-677-fa.html
ابراهیمی مهبد، اکبری اسبق فیروزه. نقش خود ایمنی در نارسائی زود هنگام تخمدان . International Journal of Reproductive BioMedicine. 1394; 13 (8) :461-472
1- بخش زنان و زایمان، بیمارستان جامع زنان محب یاس، دانشکده پزشکی، دانشگاه علوم پزشکی و خدمات درمان تهران، تهران، ایران ، Maeb214@yahoo.com
2- بخش زنان و زایمان، بیمارستان جامع زنان محب یاس، دانشکده پزشکی، دانشگاه علوم پزشکی و خدمات درمان تهران، تهران، ایران
2- بخش زنان و زایمان، بیمارستان جامع زنان محب یاس، دانشکده پزشکی، دانشگاه علوم پزشکی و خدمات درمان تهران، تهران، ایران
چکیده: (2950 مشاهده)
نارسائی زودرس تخمدان، نشانگانی با علل متفاوت است. در 30-4% موارد، این بیماری به دنبال یک واکنش خود ایمنی بروز می نماید. این مقاله مروری به نقش خود ایمنی در آسیب شناسی نارسائی زودرس تخمدان می پردازد. دلایل ارتباط خود ایمنی با این نشانگان عبارتند از: وجود اتوآنتی بادی های تخمدانی، وجود التاب تخمدانی لنفوسیتی و همراهی این بیماری با دیگر بیماری های خود ایمنی. در تخمدان بیماران مبتلا چندین جایگاه آنتی ژنی شناسائی شده است. تخمک شایع ترین سلول بروزدهنده این آنتی ژنها است. در بسیاری از موارد، التهاب تخمدانی لنفوسیتی با نارسائی غده فوق کلیوی همراه است. همجنین بیماری آدیسون از شایع ترین بیمارهای خودایمنی همراه بانارسائی زود هنگام تخمدان است. لذا یا عنایت به احتمال خطر مرگ در بیماران مبتلا به بیماری آدیسون، توصیه به شناسائی زود هنگام همراهی این بیماری با نارسائی زودرس تخمدانی شده است. نمونه گیری از تخمدان،استاندار طلائی تشخیص بیماری زودرس تخمدانی است. البته به دلایلی چون مشخص نبودن ارزش بالینی، عوارض و هزینه بالا انجام نمونه گیری توصیه نمی گردد. چندین آزمایش سرم شناسی به عنوان آزمایش جایگزین پیشنهاد شده است. معذالک، هنوزآزمایش سرم شناسی اختصاصی که حساسیت و ویژگی بالائی برای اثبات بیماری ویا پیش بینی احتمال بیماری ویا همراهی دیگر بیماری خودایمنی وجود ندارد.
برخی از محققین درمانهائی با محوریت تداخل در واکنش های ایمنی بیمار برای برگرداندن عمل کرد تخمدان و باروری توصیه نموده اند. در اغلب موارد درمانهای پیشنهادی نتوانسته پیش آگهی بیماری را تغییر دهد. بسیاری از مطالعات نشان داده اند که پیش آگهی موفقیت درمان های استاندارد ناباروی در این بیماران پایین تر از دیگر بیماران نابارور است. دلیل این یافته بالینی می تواند آسیب تخمدانی ناشی از رها شدن آنتی ژن ها باشد. اگرچه هنوز این نظریه اثبات نشده است.
برخی از محققین درمانهائی با محوریت تداخل در واکنش های ایمنی بیمار برای برگرداندن عمل کرد تخمدان و باروری توصیه نموده اند. در اغلب موارد درمانهای پیشنهادی نتوانسته پیش آگهی بیماری را تغییر دهد. بسیاری از مطالعات نشان داده اند که پیش آگهی موفقیت درمان های استاندارد ناباروی در این بیماران پایین تر از دیگر بیماران نابارور است. دلیل این یافته بالینی می تواند آسیب تخمدانی ناشی از رها شدن آنتی ژن ها باشد. اگرچه هنوز این نظریه اثبات نشده است.
نوع مطالعه: Original Article |
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