Aumento de interferom gama no aborto recorrente:uma revisão sistemática

Abstract

Embryo implantation is a high complex phenomenon involving hormonal changes in the mother, affecting immune response and the events of embryonic maturation. If such events are not synchronized there may be gestational losses. The embryo behaves in the maternal organism as a semi-allogenic graft, and is thus vulnerable to rejection and immune tolerance mechanisms. Trophoblast cells and endometrial cells synthesize one or more interferon, including IFN-γ (proinflammatory cytokine). The literature suggests that the cause of recurrent miscarriage is alloimmune rejection of the fetus. The presente study aimed tosystematically review the literature to investigate the association between IFN-γ levels and the occurrence of abortion As a methodology a systematic review was carried out on the association between interferon gamma and recurrent abortion. To analyze the quality of the studies, it was based on the Newcastle-Ottawa scale; the levels of evidence from the studies were established by the classification of degrees of recommendation proposed by the Oxford Center for Evidence-Based Medicine; and for statistical analysis, meta-analysis was used.A search was carried out in 15 databases, finding a total of 7.464 studies were searched, after following the inclusion and exclusion criteria, 48 studies were left for a detailed analysis, of which 10 articles, case controls, were eligible for this review, 4 studies inclueded for meta-analysis. In these articles, It was identified that all participants were of fertile age and also it was used as evaluation method the flow cytometry and Enzymatic Imunoadsorption Assay for interferon gamma found in the peripheral blood, decidua and endometrium. Regarding the quality of studies, all presented good quality, with moderate degree of evidence. The studies included in the meta-analysis showed high heterogeneity. However, the individual effect observed in all studies included in the meta-analysis, as well as the general effect estimate, indicated that the deciduous cells of pregnant women with a history of recurrent abortion produce significantly higher levels of IFNγ compared to the production of this cytokine in pregnant women without history of abortion. Although studies suggests an increase in IFNγ in cases of recurrent abortion further research are necessary with robust data to reinforce our results.