Материал: Донсков С.И., Мороков В.А. Группы крови человека. Руководство по иммуносерологии

Антитела анти-Р у женщин с фенотипом P k не вызывали угнетения беременности и лишь в редких случаях служили причиной легких форм ГБН (Nakagima

и соавт. [126],Yamaguchi и соавт. [174]).

Антитела анти-Р, ассоциированные с привычными выкидышами, были описаны у японской женщины с фенотипом P2 k и женщины с фенотипом P1 k жительницы Кувейта (Shirey и соавт. [150], Yoshida и соавт. [176]). У 1-й женщины было 4 самопроизвольных выкидыша, у 2-й – 13. Ни та, ни другая не имели детей. В дальнейшем обеим женщинам с 5–6 недели очередной беременности проводили плазмаферез с целью снижения титра антител. Обе женщины родили жизнеспособных детей, не нуждающихся в каком-либо специальном лечении, кроме фототерапии. В сыворотке крови женщины из Кувейта присутствовали IgM, IgG (главным образом IgG3) и IgA; такие же анти-Р-антитела были элюированы из тканей плаценты. Плазму японской женщины адсорбировали Р-положительными эритроцитами, после чего производили реинфузию (Yoshida и соавт. [176]). Имеются другие сообщения об эффективном применении плазмафереза у женщин, имеющих р-фенотип и страдающих невынашиванием бе-

ременности (Fernandez-Jimenez и соавт. [43], Rydberg и соавт. [140], Shechter [147],Yoshida и соавт. [177]).

Необычные антитела выявили Vos и соавт. [167] в Перте (Западная Австралия) у женщин с привычным невынашиванием беременности. Эти антитела вызывали гемолиз, но не агглютинировали эритроциты Р1 и Р2; тесты с эритроцитами р были отрицательными. Женщины имели фенотип Р1. Гемолизины обнаруживали в сыворотках крови только в момент самопроизвольного выкидыша, вне беременности антитела не обладали гемолитической активностью. Гемолитическая активность не была опосредована комплементом. Vos и соавт. [164–167], обследовавшие женщин, не нашли какого-либо объяснения указанному феномену.

У женщин Канады, США и Венгрии, страдавших невынашиванием беременности, подобных гемолизинов не обнаружено (Horvath и соавт. [63], Vos et al [167]).

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