Xiaofang is 29 years old this year
Married for 5 years has always wanted to have a child
But I can't always get pregnant
This made her and her husband very anxious
"Doctor, I'm always not pregnant, I've done a lot of tests, the reproductive doctor asked me to come to the rheumatology and immunology department, you see this arrow that indicates the increase, will this affect pregnancy in the end?" Xiao Fang pointed to the examination sheet and eagerly asked the doctor of the Rheumatology and Immunology Department.
Can't get pregnant
See rheumatology and immunology?
This is "emergency medical treatment"!
I believe that many people and Xiaobian have the same idea, rheumatology and immunology is not to see rheumatism, how to manage reproduction? In fact, with the opening of the national fertility policy, the rheumatology and immunology clinic also encounters more and more women who consult fertility-related issues, mainly for two reasons:
●First of all, many patients with rheumatic immune diseases are of childbearing age, such as systemic lupus erythematosus, Sjögren syndrome, rheumatoid arthritis, ankylosing spondylitis and gout, etc. Rheumatologists not only have to help patients successfully pass through the stages of pregnancy, pregnancy, childbirth and breastfeeding, and successfully give birth to cute and healthy babies, but also to control the stability of the whole process and escort the patient's health.
●Secondly, some pregnancy-related problems are closely related to the function of the immune system, and it has become an unshirkable responsibility of the Rheumatology and Immunology Department to help with pregnancy. The elevated arrow asked by the patient Xiaofang is a "star cell" in the immune system - natural killer cells (NK cells).
So, what exactly are NK cells? What role does it play in people's normal pregnancies? Why do pregnancy-related issues require joint decision-making by rheumatologists and reproductive departments?
1
What are NK cells?
The full name of NK cells is natural killer cells (Natural Killer cells), as the name suggests, its main function is to kill some foreign pathogens or their own abnormal cells, such as tumor cells, is one of the important lines of defense of the human body.
▲NK cells under electron microscopy
NK cells can accurately identify pathogens or abnormal cells because they have a wealth of activated and inhibitory receptors, which can recognize "bad things" without attacking normal cells.
2
NK cells with pregnancy
NK cells are found in the bloodstream and distributed in various tissues and organs. The proportion of NK cells in the uterus is much higher than in blood, and we also call them uterine NK cells. Uterine NK cells are different from ordinary NK cells in that their "killing ability" is weak, mainly by secreting various cytokines, growth factors and proteases to maintain pregnancy.
During normal pregnancy, NK cells mainly regulate the invasion of trophoblast cells, the remodeling of uterine spiral arteries, and the development of embryos. In simple terms, NK cells play an important role in the smooth colonization of embryos in the uterus, the supply of blood flow to the uterus, and the development of the fetus.
3
NK cells associated with immune-related adverse pregnancies
Pathological pregnancies associated with immune diseases or immune cells are also called immune-related adverse pregnancies. Abnormalities of Uterine NK cells are closely related to pathological pregnancies such as preeclampsia, fetal intrauterine growth restriction, preterm birth, late miscarriage, and placental implantation. It is the goal of the Rheumatology Department to identify the NK cells of each immune-related adverse pregnancy patient and to give appropriate treatment to tame the NK cells.
Will the situation of high NK cells like Xiaofang affect pregnancy? In fact, uterine NK cells are quite different from NK cells in blood, and the number of NK cells in the blood does not fully represent the number and function of NK cells in the uterus, especially the maternal-fetal interface. Therefore, a simple "arrow" can give us too little information.
Some small sample studies have indeed found a relationship between the number of NK cells in the blood and pathological pregnancy, but the study is not convincing enough. At the same time, there are also many treatments for Uterine NK cells, including gamma globulin, fatty milk, progesterone, low molecular weight heparin and glucocorticoids, which are indeed effective for some patients. However, due to the fact that the cause of immune-related poor pregnancy patients is often not single, there are also patients whose treatment effect is not ideal.
Therefore, we should recognize that the dysfunction of NK cells is an important cause of immune-related adverse pregnancy, but due to the inability to directly obtain the NK cells of the maternal-fetal interface, it is difficult to judge the condition by relying only on blood NK cells, and more importantly, it is necessary for rheumatologists and immunologists to cooperate with reproductive departments and obstetricians to analyze the patient's situation specifically, determine whether there is an immune-related adverse pregnancy and related states, give appropriate treatment plans, and work together with expectant mothers to welcome the arrival of new life.
Department of Rheumatism and Immunology, Second Hospital of Zhejiang University
Text | Rheumatology and Immunology Department Liu Lei Xue Jing
| Chen Guozhong Wu Huaxiang Jin Min Feng Chun
Editor-in-charge | Chen Dan