甲状腺自身抗体阳性与早产发生风险的meta分析  

Thyroid autoantibody and risk of preterm birth： a meta-analysis of prospective cohort studies

作　　者：王增芳[1] 胡吉英[1] 王萍萍[1] 谭莹[1] 连文静[1] 田花香[1] 王斌[1] 

机构地区：[1]山东省潍坊市妇幼保健院产科,261000

出　　处：《中华围产医学杂志》2013年第5期257-261,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨孕妇甲状腺自身抗体阳性与早产风险的关系。方法计算机检索PubMed、EMBASE、中国学术期刊网络出版总库、万方医学数据库和中国生物医学文献数据库，收集1989年1月1日至2012年1月26日期间发表的相关文献。纳入标准：（1）前瞻性队列研究；（2）暴露为甲状腺抗体阳性，目标事件为早产；（3）研究对象为孕妇，不合并心血管疾病、风湿免疫疾病；（4）有甲状腺自身抗体阳性孕妇早产风险的相对危险（relativerisk，RR）值及其95％可信区间（95％confidenceinterval，95％CI）。采用Stata12．0软件进行meta分析，依据RR值及其95％CI评估孕妇甲状腺自身抗体阳性与早产风险的关系。结果共纳入10篇队列研究文献，总队列人数25081例，累计发生早产1657例，异质性检验I^2=79．2％（P〈0．01），采用随机效应模型分析，甲状腺自身抗体阳性孕妇发生早产的风险高于对照组（RR=1．61，95％CI：1．18～2．20，P〈o．05）。亚组分析结果显示，5篇文献的对照组为甲状腺功能正常的孕妇，异质性检验I^2=39．1％（P=0．160），甲状腺自身抗体阳性孕妇发生早产风险的RR值为2．55（95％CI：2．04～3．19，P〈0．01）；另外5篇文献的对照组为未排除甲状腺功能不全的孕妇，异质性检验I^2=0．0％（P=0．970），甲状腺自身抗体阳性孕妇发生早产风险的RR值为1．18（95％CI：1．01～1．37，P〈0．05）。排除2篇质量评价〈6分的文献后分析，甲状腺自身抗体阳性孕妇发生早产风险的RR值为1．72（95％CI：1．18～2．53，P〈0．05）。漏斗图的对称性较好，不存在发表偏移。结论孕妇甲状腺自身抗体阳性是早产的危险因素。Objective To evaluate the relationship between positive thyroid autoantibody and risk of preterm birth, Methods Literature search was done in PubMed, Embase, China Academic Journal Network Publishing Database, Wanfang Medical Database and China Biology Medicine disc databases from January 1st, 1989 to January 26th, 2012. Criteria for inclusion included： （1） Prospective cohort study; （2） The exposure was positive thyroid autoantibody and outcome was preterm birth; （3） The enrolled subjects were pregnant women without cardiovascular or rheumatic disease; （4） Relative risk （RR） and its 95% confidence interval （95% CI） of preterm birth were provided in the study. Meta-analysis was performed by Stata 12.0. The relationship between positive thyroid autoantibody and risk of preterm birth was evaluated by RR and 95% CI. Results Ten cohort studies were enrolled. One thousand six hundred and fifty seven cases of preterm birth occurred among 25 081 pregnant women. Heterogeneity among the 10 studies was found in meta-analysis （12 = 79.2%, P〈0.01）. The risk of preterm birth in pregnant women with positive thyroid autoantibody was higher than those in control group by random effects analysis （RR= 1.61, 95GCI： 1.18-2.20, P〈20.05）. Subgroup analysis was further performed. In five studies, the cases of control group were pregnant women with normal thyroid functiom heterogeneity was not found in these five studies （12= 39.1% ,P=0. 160）; and RR of the risk of preterm birth was 2.55 in pregnant women with positive thyroid autoantibody （95 % CI ： 2.04-3.19, P〈 0.01）. In the other five studies, the cases of control group were pregnant women who had not been ruled out the possibility of thyroid dysfunction; heterogeneity was not found in these five studies either （I^2 = 0.0%, P= 0. 970） ; and RR was 1.18 （95%CI： 1.01-1.37, P〈0.05）. After excluding two low-quality studies, RR of the risk of preterm birth was 1.72 in pregnant women with positive thyroid autoantibody （95%CI

关 键 词：早产 甲状腺 自身抗体 危险因素 META分析 

分 类 号：R714[医药卫生—妇产科学]