Иммунологический «ландшафт» индуцированной беременности: цитокиновая сеть как предиктор исходов вспомогательных репродуктивных технологий и мишень для персонализированной терапии

Обоснование. Несмотря на постоянное совершенствование проводимых программ вспомогательных репродуктивных технологий (ВРТ), показатели успешной имплантации эмбриона и наступления клинической беременности сильно варьируют, а частота ранних потерь беременности остается значительной. Ключевая роль в имплантации и поддержании беременности принадлежит балансу цитокинов, нарушения которого выступают важным фактором риска неудач ВРТ.

Цель работы. Систематизировать современные представления о роли цитокиновой сети в наступлении и поддержании индуцированной беременности и оценить клиническую значимость цитокинового профиля как инструмента для прогнозирования и потенциальной коррекции репродуктивных неудач. Материалом для анализа послужили публикации, индексированные в международных базах данных Web of Science, Scopus, PubMed и в отечественной базе данных РИНЦ, глубина поиска составила 5 лет (2020–2025 г.).

Основные положения. Цитокиновая сеть — фундаментальный регулятор имплантации и поддержания индуцированной беременности. Дисбаланс в сторону провоспалительных (Th1) цитокинов, таких как TNF-α, IFN-γ, IL-1β, может являться наиболее значимым фактором неудач имплантации, ранних потерь беременности и осложнений беременности после процедуры ВРТ. Напротив, адекватный уровень противовоспалительных и иммунорегуляторных (Th2/Treg) цитокинов IL-10, TGF-β, IL-35, и адекватная активность Treg создают оптимальную среду для имплантации и развития эмбриона и коррелируют с благоприятными исходами. Персонализированный подход, основанный на выявлении цитокинового дисбаланса и его таргетной коррекции, включая иммуномодуляцию, применение факторов роста, внутриматочное введение Treg, представляет собой перспективную стратегию для повышения эффективности ВРТ и снижения частоты репродуктивных неудач.

Заключение. Результаты проанализированных исследований вносят существенный вклад в репродуктивную иммунологию, предлагая научно обоснованные подходы к повышению эффективности ВРТ и снижению частоты репродуктивных неудач через призму управления иммунным «ландшафтом» индуцированной беременности.

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