{"id":1225,"date":"2017-09-26T14:57:43","date_gmt":"2017-09-26T12:57:43","guid":{"rendered":"http:\/\/www.newslab.sk\/?p=1225\/"},"modified":"2017-09-27T07:18:32","modified_gmt":"2017-09-27T05:18:32","slug":"fertility-disorders-immunological-causes-and-possible-curative-impact","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/fertility-disorders-immunological-causes-and-possible-curative-impact\/","title":{"rendered":"Fertility disorders: immunological causes and possible curative impact"},"content":{"rendered":"<pre><strong><span style=\"color: #ff0000;\">*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf \r\nattachment at the end of the paper.<\/span> <\/strong><\/pre>\n<p>&nbsp;<\/p>\n<p><strong>\u00davod<\/strong><br \/>\nPr\u00ed\u010diny patologick\u00e9ho priebehu tehotenstva m\u00f4\u017eu by\u0165 r\u00f4zne. Po vyl\u00fa\u010den\u00ed genetickej, hormon\u00e1lnej, anatomickej, infek\u010dnej a hematologickej pr\u00ed\u010diny poruchy plodnosti sa testuje pr\u00edtomnos\u0165 patologick\u00fdch mechanizmov imunitn\u00e9ho syst\u00e9mu. Tie zodpovedaj\u00fa a\u017e za 40 \u2013 60 % neobjasnen\u00fdch pr\u00edpadov por\u00fach plodnosti. \u010casto sa na neplodnosti podie\u013ea nieko\u013eko faktorov s\u00fa\u010dasne. Imunitn\u00fd syst\u00e9m m\u00e1 v\u00fdrazn\u00fa \u00falohu pri intolerancii plodu najm\u00e4 u pacientok s u\u017e rozvinut\u00fdm syst\u00e9mov\u00fdm patoimunologick\u00fdm stavom (imunodeficiencie, alergie, autoimunitn\u00e9 ochorenia). Reproduk\u010dn\u00e1 schopnos\u0165 m\u00f4\u017ee by\u0165 zasiahnut\u00e1 abnorm\u00e1lne regulovan\u00fdmi funkciami na r\u00f4znych \u00farovniach. V z\u00e1rodo\u010dn\u00fdch tkaniv\u00e1ch mu\u017ea aj \u017eeny m\u00f4\u017ee by\u0165 pr\u00edtomn\u00e1 ak\u00fatna aj chronick\u00e1 z\u00e1palov\u00e1 reakcia, ktorej v\u00fdsledkom je lok\u00e1lne zn\u00ed\u017een\u00e1 tolerancia semialog\u00e9nneho plodu. U \u017eien m\u00f4\u017ee by\u0165 pr\u00ed\u010dinou infertility autoimunitn\u00e1 (napr. syst\u00e9mov\u00fd lupus erytematodus) aj aloimunitn\u00e1 reakcia organizmu(1).<\/p>\n<p>Aloimunitn\u00e9 reakcie vznikaj\u00fa v d\u00f4sledku poruchy v regul\u00e1cii imunitn\u00fdch efektorov, ktorej v\u00fdsledkom je reakcia namieren\u00e1 proti plodu namiesto navodenia tolerancie. D\u00f4le\u017eit\u00fa \u00falohu pri neplodnosti m\u00e1 poru\u0161enie preklopenia pomeru TH1-\/ TH2-lymfocytov. Ak sa hladina TH2-lymfocytov a cytok\u00ednov nimi<br \/>\nprodukovan\u00fdch (najm\u00e4 IL-4) nezv\u00fd\u0161i na \u00farove\u0148, ktor\u00e1 dok\u00e1\u017ee zabezpe\u010di\u0165 utlmenie embryotoxickej aktivity TH1-lymfocytov a ich efektorov, v\u00fdznamne sa zvy\u0161uje riziko odvrhnutia plodu matersk\u00fdm organizmom. TH1-lymfocyty produkuj\u00fa cytok\u00edny, ktor\u00e9 aktivuj\u00fa \u010fal\u0161ie efektory namieren\u00e9 proti plodu.<br \/>\nSpomedzi nich je v\u00fdrazn\u00e1 aktiv\u00e1cia NK-buniek a makrof\u00e1gov. Z cytok\u00ednov, ktor\u00e9 produkuj\u00fa TH1-lymfocyty, m\u00e1 v\u00fdznamn\u00fa \u00falohu pri aktiv\u00e1cii embryotoxick\u00fdch efektorov najm\u00e4 IL-1 a IFN-\u03b3. IFN-\u03b3 je okrem priameho toxick\u00e9ho p\u00f4sobenia na plod schopn\u00fd aktivova\u0165 trofoblast na tvorbu HLA-znakov.<br \/>\nZv\u00fdraznen\u00fd povrch trofoblastu je potom jednoduch\u0161\u00ed ter\u010d pre protil\u00e1tky aj bunky s cytotoxick\u00fdm p\u00f4soben\u00edm(1). TH1-lymfocyty produkuj\u00fa aj IL-2 a TNF, ktor\u00e9 spolu s IFN-\u03b3 p\u00f4sobia embryotoxicky, t. j. po\u0161kodzuj\u00fa endotel cievneho z\u00e1sobenia plodu. TNF p\u00f4sob\u00ed ako stimul\u00e1tor programovanej smrti buniek<br \/>\nvil\u00f3zneho trofoblastu. IFN-\u03b3 sp\u00f4sobuje de\u0161trukciu buniek trofoblastu mediovan\u00fa TNF(2). Spom\u00ednan\u00e9 mechanizmy\u00a0rezultuj\u00fa do prokoagula\u010dn\u00fdch procesov, ktor\u00e9 sa kon\u010dia tromb\u00f3zou, isch\u00e9miou a smr\u0165ou plodu.<br \/>\nAutoimunitn\u00e9 reakcie m\u00f4\u017eu prebieha\u0165 proti z\u00e1rodo\u010dn\u00fdm bunk\u00e1m pohlavn\u00e9ho syst\u00e9mu \u017eien aj mu\u017eov. Neplodnos\u0165 mu\u017eov m\u00f4\u017ee by\u0165 zapr\u00ed\u010dinen\u00e1 autoprotil\u00e1tkami proti spermi\u00e1m aj imunitn\u00fdmi celul\u00e1rnymi mechanizmami namieren\u00fdmi proti spermi\u00e1m. U \u017eien s poruchami plodnosti sa m\u00f4\u017eu nach\u00e1dza\u0165 autoprotil\u00e1tky proti ov\u00e1ri\u00e1m, zona pellucida a protil\u00e1tky proti spermi\u00e1m. Z autoimunitn\u00fdch procesov, ktor\u00e9 po\u0161kodzuj\u00fa priamo plod, je naj\u010dastej\u0161\u00ed antifosfolipidov\u00fd syndr\u00f3m (APS). Pri APS sa vyskytuj\u00fa v tele \u017eeny antifosfolipidov\u00e9 protil\u00e1tky proti \u03b22-glykoprote\u00ednu I, ktor\u00fd je s\u00fa\u010das\u0165ou membr\u00e1n cievneho endotelu, protil\u00e1tky proti anex\u00ednu V a mno\u017estvo in\u00fdch. Aktivita antifosfolipidov\u00fdch protil\u00e1tok spo\u010d\u00edva v po\u0161kodzovan\u00ed<br \/>\nciev v deciduu a placente, \u010do m\u00e1 za n\u00e1sledok trombotick\u00e9 pr\u00edhody a miestne infarkty(3). Pre ka\u017ed\u00fd z t\u00fdchto stavov je potrebn\u00e9 stanovi\u0165 najefekt\u00edvnej\u0161iu<br \/>\nlie\u010dbu. V s\u00fa\u010dasnosti sa naj\u010dastej\u0161ie vyu\u017e\u00edva lie\u010dba imunoglobul\u00ednmi alebo kortikosteroidmi. Ka\u017ed\u00e1 z nich v\u0161ak nesie negat\u00edva; imunoglobul\u00edny s\u00fa n\u00e1kladn\u00e9 a nie v\u017edy sa nimi dosiahne uspokojiv\u00fd \u00fa\u010dinok, na druhej strane kortikosteroidy maj\u00fa \u0161irok\u00e9 spektrum ne\u017eiaducich \u00fa\u010dinkov, ktor\u00e9 sa prejavuj\u00fa u pomerne ve\u013ek\u00e9ho percenta u\u017e\u00edvate\u013eov. Ke\u010f\u017ee neexistuje ofici\u00e1lny algoritmus pre vo\u013ebu konkr\u00e9tnej lie\u010dby pre dan\u00e9 probl\u00e9my, lek\u00e1ri sa pri vo\u013ebe lie\u010debnej sch\u00e9my riadia sk\u00f4r empiricky. Pri rast\u00facej incidencii por\u00fach plodnosti je potrebn\u00e9 jednozna\u010dne stanovi\u0165, ak\u00e9 konkr\u00e9tne lie\u010divo a pri ktor\u00fdch patologicky zv\u00fd\u0161en\u00fdch parametroch bude met\u00f3dou prvej vo\u013eby. Umo\u017enilo by to r\u00fdchlej\u0161iu a terapeuticky aj ekonomicky efekt\u00edvnej\u0161iu lie\u010dbu.<\/p>\n<p><strong>Metodika pr\u00e1ce<\/strong><br \/>\nV \u0161t\u00fadii sme spracovali \u00fadaje z chorobopisov pacientok, ktor\u00e9 sa lie\u010dili v imunologickom centre ImunoVital od novembra 2014 do febru\u00e1ra 2016. S\u00fabor pozost\u00e1val z 81 \u017eien v reproduk\u010dnom veku, ktor\u00e9 trpeli poruchami plodnosti, t. j. spont\u00e1nnymi opakovan\u00fdmi potratmi alebo neplodnos\u0165ou<br \/>\n(neschopnos\u0165ou po\u010da\u0165 plod). Sledovan\u00fdm pacientkam sa odobrala krv na komplexn\u00e9 imunologick\u00e9 vy\u0161etrenie, na z\u00e1klade ktor\u00e9ho sme ur\u010dili, ktor\u00e9 parametre sa nach\u00e1dzaj\u00fa mimo referen\u010dn\u00fdch hodn\u00f4t. Pacientky n\u00e1sledne podst\u00fapili jednu z troch sk\u00fa\u0161an\u00fdch terapi\u00ed: subkut\u00e1nna aplik\u00e1cia imunoglobul\u00ednov (liek Subcuvia), injek\u010dn\u00e1 aplik\u00e1cia dexametaz\u00f3nu (Dexamed) alebo peror\u00e1lna aplik\u00e1cia metylprednizol\u00f3nu (Medrol). D\u013a\u017eka terapie sa pohybovala v rozmedz\u00ed 6 \u2013 12 t\u00fd\u017ed\u0148ov. Po tomto \u010dase nasledovalo kontroln\u00e9 imunologick\u00e9 vy\u0161etrenie t\u00fdch parametrov, ktor\u00e9 vykazovali pri vstupnom<br \/>\nvy\u0161etren\u00ed patologicky zv\u00fd\u0161en\u00e9 hodnoty. V\u0161etky laborat\u00f3rne \u00fadaje sa z\u00edskali z imunologick\u00e9ho laborat\u00f3ria spolo\u010dnosti rozdelili do troch skup\u00edn, pri\u010dom krit\u00e9riami na zaradenie do danej skupiny boli v 1. skupine zv\u00fd\u0161en\u00e9 hodnoty IFN-\u03b3 alebo TNF, v 2. skupine zv\u00fd\u0161en\u00e9 percento NK-buniek a v 3. skupine<br \/>\nzv\u00fd\u0161en\u00e9 hodnoty antifosfolipidov\u00fdch protil\u00e1tok nad referen\u010dn\u00e9 hodnoty. Imunologick\u00e9 parametre sme spracovali Studentov\u00fdm p\u00e1rov\u00fdm t-testom v programe Microsoft Office Excel 2013 (Microsoft, USA). N\u00e1sledne sme sa sna\u017eili ur\u010di\u0165, ktor\u00e1 lie\u010dba sa jav\u00ed ako najvhodnej\u0161ia na \u00fapravu jednotliv\u00fdch patologicky zv\u00fd\u0161en\u00fdch parametrov na fyziologick\u00e9 hodnoty.<\/p>\n<p><strong>V\u00fdsledky<\/strong><br \/>\nNa z\u00e1klade stanovenia intracelul\u00e1rnej hladiny IFN-\u03b3 v bunk\u00e1ch s povrchov\u00fdmi znakmi CD3+ a CD3+CD4+ sme zistili, \u017ee pri bunk\u00e1ch s CD3+ znakmi do\u0161lo k \u0161tatisticky v\u00fdznamn\u00e9mu zn\u00ed\u017eeniu hladiny IFN-\u03b3 pri v\u0161etk\u00fdch typoch lie\u010dby (Subcuvia: pokles priemerne o 2,23 percentu\u00e1lneho bodu (p = 0,026), Dexamed: pokles o 3,74 percentu\u00e1lneho bodu (p = 0,0007), Medrol: pokles o 4,6 percentu\u00e1lneho bodu (p = 0,004)) a pri bunk\u00e1ch s povrchov\u00fdmi znakmi CD3+CD4+ sme zaznamenali \u0161tatisticky signifikantn\u00fd terapeutick\u00fd efekt len pri lie\u010dbe Medrolom (pokles IFN-\u03b3 o 2,54 percentu\u00e1lneho bodu (p = 0,019)).<br \/>\nPreh\u013ead v\u00fdsledkov uv\u00e1dzame v tabu\u013eke 1. V \u010fal\u0161om kroku sme analogicky stanovili intracelul\u00e1rne hodnoty TNF. Pod\u00e1vanie Subcuvie nejavilo \u0161tatisticky v\u00fdznamn\u00e9 zn\u00ed\u017eenie hlad\u00edn TNF (p &gt; 0,05). Po pod\u00e1van\u00ed oboch kortikoidov do\u0161lo k \u0161tatisticky v\u00fdznamn\u00e9mu poklesu hlad\u00edn TNF (Dexamed: v bunk\u00e1ch so znakmi CD3+ pokles o 5,01 percentu\u00e1lneho bodu (p = 0,002) a v bunk\u00e1ch s CD3+CD4+ znakmi pokles o 6,20 percentu\u00e1lneho bodu (p = 0,002), Medrol: v bunk\u00e1ch s CD3+ znakmi pokles o 5,96 percentu\u00e1lneho bodu (p = 0,022) a v bunk\u00e1ch so znakmi CD3+CD4+ pokles o 5,73 percentu\u00e1lneho bodu (p = 0,025)). Preh\u013ead v\u00fdsledkov zn\u00e1zor\u0148uje tabu\u013eka 2.<br \/>\nN\u00e1sledne sme stanovili pomer TH1-\/TH2-lymfocytov, ktor\u00fd bol reprezentovan\u00fd pomerom cytok\u00ednov produkovan\u00fdch TH1-lymfocytmi (IFN-\u03b3 a TNF) k principi\u00e1lnemu cytok\u00ednu produkovan\u00e9mu TH2-lymfocytmi (IL-4). Pri sledovan\u00ed pomeru IFN-\u03b3\/IL-4 (CD3+) sme odhalili pri v\u0161etk\u00fdch sk\u00fa\u0161an\u00fdch liekoch \u0161tatisticky v\u00fdznamn\u00e9 zv\u00fd\u0161enie pomeru v prospech TH1-lymfocytov (Medrol: n\u00e1rast pomeru o 3,78 jednotky v prospech IFN-\u03b3 (p = 0,00002), Dexamed: n\u00e1rast o 2,69 jednotky (p = 0,026), Subcuvia: n\u00e1rast o 2,19 jednotky (p = 0,003) (graf 1). Analogicky sme postupovali aj pri bunk\u00e1ch nes\u00facich<br \/>\npovrchov\u00e9 markery CD3+CD4+ (Medrol: n\u00e1rast pomeru o 6,67 jednotky, Subcuvia a Dexamed nss (p &gt; 0,05). \u010ealej sme sledovali pomer TH1-\/TH2-lymfocytov prezentovan\u00fd cytok\u00ednmi TNF a IL-4 pri bunk\u00e1ch s CD3+ znakmi (Medrol: n\u00e1rast pomeru TNF\/IL-4 o 4,54 jednotky (p = 0,0001), Dexamed: n\u00e1rast pomeru o 3,62 jednotky (p = 0,013), Subcuvia: n\u00e1rast o 3,21 jednotky (p = 0,004)) (graf 2) a CD3+CD4+<br \/>\nznakmi (Medrol: n\u00e1rast o 8,52 jednotky (p = 0,00003), Dexamed a Subcuvia nss (p &gt; 0,05).<br \/>\n\u010eal\u0161\u00edm z cie\u013eov \u0161t\u00fadie bolo porovna\u0165 popul\u00e1ciu NK-buniek (CD3-CD56+). Dexamedom bola lie\u010den\u00e1 iba jedna pacientka, preto sme ho nezahrnuli do \u0161tatistick\u00e9ho spracovania d\u00e1t (popul\u00e1cia NK-buniek pred lie\u010dbou 17,77 %, po lie\u010dbe pokles na 8,37 %). V\u00fdznamn\u00fd bol pokles NK-buniek po lie\u010dbe<br \/>\nMedrolom, priemerne pokles o 8,84 percentu\u00e1lneho bodu (p = 0,011). Pri lie\u010dbe Subcuviou neboli pozorovane \u0161tatisticky signifikantn\u00e9 zmeny v popul\u00e1cii NK-buniek (graf 3). V poslednej \u010dasti \u0161t\u00fadie sme monitorovali hladiny antifosfolipidov\u00fdch protil\u00e1tok (APA). Najvy\u0161\u0161iu \u00faspe\u0161nos\u0165 dosiahla lie\u010dba Dexamedom, ktor\u00fa podst\u00fapilo 6 pacientok (n = 5 pokles APA na referen\u010dn\u00e9 hodnoty, n = 1 bez odpovede). Liek Subcuvia sa pod\u00e1val 3 pacientkam (n = 2 pokles APA na fyziologick\u00e9 hodnoty, n = 1 bez odpovede). Peror\u00e1lnym kortikosteroidom Medrol sa lie\u010dilo 9 pacientok (n = 4 \u00faprava hlad\u00edn APA na fyziologick\u00e9, n = 5 bez odpovede).<\/p>\n<p><strong>Diskusia<\/strong><br \/>\nAko prv\u00e9 sme u pacientok s imunologicky zapr\u00ed\u010dinen\u00fdmi poruchami plodnosti porovn\u00e1vali hodnoty proz\u00e1palov\u00fdch TH1 cytok\u00ednov (IFN-\u03b3, TNF) pred lie\u010dbou a po 6 \u2013 12 t\u00fd\u017ed\u0148och lie\u010dby Subcuviou, Dexamedom a Medrolom. Dostupn\u00e9 zdroje uv\u00e1dzaj\u00fa, \u017ee vhodn\u00fdmi lie\u010divami na zn\u00ed\u017eenie hlad\u00edn dan\u00fdch cytok\u00ednov sa zdaj\u00fa imunoglobul\u00edny a glukokortikoidy(4). Z na\u0161ich v\u00fdsledkov vypl\u00fdva, \u017ee lie\u010dba metylprednizol\u00f3nom (Medrol) m\u00e1 najv\u00fdraznej\u0161\u00ed efekt na zn\u00ed\u017eenie zv\u00fd\u0161en\u00fdch hodn\u00f4t IFN-\u03b3. Zv\u00fd\u0161en\u00e9 hodnoty TNF sa \u00fa\u010dinne zn\u00ed\u017eili aplik\u00e1ciou kortikosteroidov, pri\u010dom \u00fa\u010dinnos\u0165 dexametaz\u00f3nu a metylprednizol\u00f3nu sa zd\u00e1 podobn\u00e1. Z v\u00fdsledkov mo\u017eno usudzova\u0165, \u017ee pri zv\u00fd\u0161en\u00fdch hodnot\u00e1ch TH1 cytok\u00ednov je najvhodnej\u0161ia\u00a0lie\u010dba peror\u00e1lne pod\u00e1van\u00fdm metylprednizol\u00f3nom. T\u00e1to lie\u010dba je z\u00e1rove\u0148 najlacnej\u0161ia a najjednoduch\u0161ie sa aplikuje, \u010do m\u00f4\u017ee prispie\u0165 k zv\u00fd\u0161eniu kompliancie pacientok.<br \/>\nV \u010fal\u0161ej \u010dasti pr\u00e1ce sme vytvorili pomer TH1-\/TH2-lymfocytov na z\u00e1klade pomeru cytok\u00ednov produkovan\u00fdch t\u00fdmito bunkami, t. j. pomer IFN-\u03b3\/IL-4 a TNF\/IL-4. Dalo by sa o\u010dak\u00e1va\u0165, \u017ee ke\u010f jednotliv\u00e9 lie\u010div\u00e1 zni\u017euj\u00fa hodnoty proz\u00e1palov\u00fdch TH1 cytok\u00ednov, pomer TH1-\/TH2-lymfocytov sa bude zni\u017eova\u0165.<br \/>\nV\u00fdsledkom lie\u010dby v\u0161ak bolo vo v\u0161etk\u00fdch pr\u00edpadoch zv\u00fd\u0161enie pomeru v prospech TH1-lymfocytov. D\u00e1 sa to vysvetli\u0165 t\u00fdm, \u017ee aj ke\u010f hodnoty proz\u00e1palov\u00fdch cytok\u00ednov klesaj\u00fa, hodnoty tlmiv\u00e9ho IL-4 klesaj\u00fa e\u0161te v\u00fdraznej\u0161ie. Je diskutabiln\u00e9, \u010di m\u00e1 zmysel sledova\u0165 pomer TH1-\/TH2-lymfocytov pred samotn\u00fdm po\u010dat\u00edm. A\u017e do momentu oplodnenia je pre telo fyziologick\u00e9, \u017ee TH1-lymfocyty v krvi prevl\u00e1daj\u00fa \u2013 svoj\u00edm p\u00f4soben\u00edm zabezpe\u010duj\u00fa boj proti cudzorod\u00fdm antig\u00e9nom, ktor\u00fd je nevyhnutn\u00fd na zachovanie integrity organizmu. A\u017e po oplodnen\u00ed nast\u00e1va fyziologick\u00e9 preklopenie pomeru v prospech tlmiv\u00fdch TH2-lymfocytov. V\u00fdsledky m\u00f4\u017eu by\u0165 n\u00e1pomocn\u00e9 v pr\u00edpadoch, ke\u010f s\u00fa okrem zv\u00fd\u0161en\u00fdch TH1 cytok\u00ednov z\u00e1rove\u0148 zn\u00ed\u017een\u00e9 hodnoty TH2 cytok\u00ednov. V t\u00fdchto pr\u00edpadoch je d\u00f4le\u017eit\u00e9, aby lie\u010dba popri zni\u017eovan\u00ed proz\u00e1palov\u00fdch cytok\u00ednov neviedla k e\u0161te v\u00fdraznej\u0161iemu preh\u013abeniu deficitu<br \/>\ntlmiv\u00fdch TH2 cytok\u00ednov. Ke\u010f\u017ee pomer TH1-\/TH2-lymfocytov vo v\u0161etk\u00fdch skupin\u00e1ch najmenej zvy\u0161ovala lie\u010dba imunoglobul\u00ednmi<br \/>\n(Subcuvia), v t\u00fdchto situ\u00e1ci\u00e1ch sa zd\u00e1 vhodnou vo\u013ebou. Mimo t\u00fdchto pr\u00edpadov snahou zost\u00e1va \u010do najviac zn\u00ed\u017ei\u0165 TH1 cytok\u00edny, ktor\u00e9 pre svoje embryotoxick\u00e9 p\u00f4sobenie predstavuj\u00fa pre tehotenstvo v\u00e4\u010d\u0161ie riziko. Najv\u00fdraznej\u0161ia redukcia zv\u00fd\u0161enej popul\u00e1cie NK-buniek sa dosiahla pri lie\u010dbe kortikosteroidmi. Tieto v\u00fdsledky s\u00fahlasia s v\u00fdsledkami viacer\u00fdch publikovan\u00fdch \u0161t\u00fadi\u00ed(5). Aj ke\u010f vo v\u0161eobecnosti sa \u017eiadne z pou\u017e\u00edvan\u00fdch lie\u010div nepova\u017euje za<br \/>\n\u0161pecifick\u00e9 pre NK-bunky, za naj\u00fa\u010dinnej\u0161ie sa pokladaj\u00fa imunoglobul\u00edny a metylprednizol\u00f3n(6). Pri zv\u00fd\u0161en\u00fdch hodnot\u00e1ch APA dosiahla najvy\u0161\u0161iu \u00faspe\u0161nos\u0165<br \/>\nlie\u010dba Dexamedom. Viacer\u00e9 dostupn\u00e9 \u0161t\u00fadie porovn\u00e1vali \u00faspe\u0161nos\u0165 lie\u010dby pacientok s APA po\u010das tehotenstva. Vaquero a kol. dok\u00e1zali pribli\u017ene rovnak\u00fa \u00fa\u010dinnos\u0165 predniz\u00f3nu a imunoglobul\u00ednov pri zna\u010dne ni\u017e\u0161om po\u010dte tehotensk\u00fdch komplik\u00e1ci\u00ed u IVIg(7). V\u00fdsledky na\u0161ej pr\u00e1ce potvrdzuj\u00fa \u00faspe\u0161nos\u0165<br \/>\nlie\u010dby imunoglobul\u00ednmi, v\u00fdraznej\u0161\u00ed efekt sa v\u0161ak uk\u00e1zal pri lie\u010dbe dexametaz\u00f3nom.<\/p>\n<p><strong>Z\u00e1ver<\/strong><br \/>\nSnahou tejto pr\u00e1ce bolo prinies\u0165 z\u00e1very, ktor\u00e9 by pomohli lek\u00e1rom s vo\u013ebou vhodn\u00e9ho lie\u010diva a sl\u00fa\u017eili ako z\u00e1klad pre \u010fal\u0161ie sk\u00famanie problematiky. Je samozrejm\u00e9, \u017ee v oblasti medic\u00edny pracujeme s v\u00fdraznou interindividu\u00e1lnou variabilitou a odpove\u010f ka\u017edej pacientky na t\u00fa ist\u00fa lie\u010dbu sa m\u00f4\u017ee l\u00ed\u0161i\u0165. Preto zd\u00f4raz\u0148ujeme potrebu \u0161ir\u0161ieho v\u00fdskumu problematiky na v\u00e4\u010d\u0161ej vzorke pacientok. V\u00fdsledkom \u010fal\u0161\u00edch v\u00fdskumov by tak mohlo by\u0165 zostavenie algoritmu na lie\u010dbu por\u00fach plodnosti, ktor\u00fd na poli slovenskej medic\u00edny absentuje.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper. &nbsp; \u00davod Pr\u00ed\u010diny patologick\u00e9ho priebehu tehotenstva m\u00f4\u017eu by\u0165 r\u00f4zne. Po vyl\u00fa\u010den\u00ed genetickej, hormon\u00e1lnej, anatomickej, infek\u010dnej a hematologickej pr\u00ed\u010diny poruchy plodnosti sa testuje pr\u00edtomnos\u0165 patologick\u00fdch mechanizmov imunitn\u00e9ho syst\u00e9mu. Tie zodpovedaj\u00fa a\u017e<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[291],"tags":[482,480,481,478,479],"class_list":["post-1225","post","type-post","status-publish","format-standard","hentry","category-imunology","tag-antiphospholipid-antibodies","tag-dexamethasone","tag-methylprednisolone","tag-reproductive-disorders","tag-subcutaneous-immunoglobulins","typ_clanku-original-work"],"acf":{"abstrakt":"<p>The aim of this study was to compare selected pathologically increased immunological parameters in infertile women before and after therapy with three tested drugs and in accordance with acquired results to propose the first-line drugs in various immunopathologic states. In the group of 81 patients, we compared IFN-\u03b3 and TNF levels in the cells with CD3+ and CD3+CD4+ markers, TH1\/TH2 lymphocyte balance, percentage of NK cells and antiphospholipid antibodies (APA) levels before the therapy and after 6 \u2013 12 week-treatment with the preparate Subcuvia (immunoglobulins), Dexamed (dexamethasone) or Medrol (methylprednisolone). Methylprednisolone achieved the highest reduction of increased IFN-\u03b3 levels. When examining TNF levels and NK cell levels, the best results were observed in both cases after treatment with corticosteroids. Increased levels of APA were most effectively reduced with dexamethasone and immunoglobulins.<\/p>\n<p><strong>Keywords:<\/strong> reproductive disorders, subcutaneous immunoglobulins, dexamethasone, methylprednisolone, antiphospholipid<br \/>\nantibodies.<\/p>\n","casopis":[{"ID":1223,"post_author":"7","post_date":"2017-09-26 14:15:30","post_date_gmt":"2017-09-26 12:15:30","post_content":"<ul>\r\n \t<li>Fertility disorders: immunological causes and possible curative impact<\/li>\r\n \t<li>The first results of galactose-deficient IgA1 measurement in diagnosis and monitoring of patients with IgA nephropathy<\/li>\r\n \t<li>Application of autovaccines in the treatment of chronic and recurrent colpitises<\/li>\r\n \t<li>Infections of the hip endoprostheses<\/li>\r\n \t<li>Non-invasive markers of liver fibrosis<\/li>\r\n<\/ul>","post_title":"Newslab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab-2017-2","to_ping":"","pinged":"","post_modified":"2017-09-26 14:19:35","post_modified_gmt":"2017-09-26 12:19:35","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.newslab.sk\/casopis\/newslab-2017-2\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"73","upload_clanok":{"ID":1227,"id":1227,"title":"NEWSLAB 2-2017_Ondreji\u010dkov\u00e1","filename":"NEWSLAB-2-2017_Ondreji\u010dkov\u00e1.pdf","filesize":951884,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2017\/09\/NEWSLAB-2-2017_Ondreji\u010dkov\u00e1.pdf","link":"https:\/\/www.newslab.sk\/en\/fertility-disorders-immunological-causes-and-possible-curative-impact\/newslab-2-2017_ondrejickova-2\/","alt":"","author":"7","description":"","caption":"","name":"newslab-2-2017_ondrejickova-2","status":"inherit","uploaded_to":1225,"date":"2017-09-26 12:56:56","modified":"2017-09-26 12:56:56","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1225","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=1225"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1225\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=1225"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=1225"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=1225"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}