妊娠早期合并临床或亚临床甲状腺功能减退症和甲状腺自身抗体阳性与早产发生风险的荟萃分析  

Clinical or subclinical hypothyroidism and thyroid autoantibody before 20 weeks pregnancy and risk of preterm birth： a systematic review

作　　者：王少为[1] 李旻[1] 褚德发[1] 梁琳[1] 赵晓东[1] 张俊荣[1] 

机构地区：[1]北京医院妇产科,100730

出　　处：《中华妇产科杂志》2014年第11期816-822,共7页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的 探讨妊娠早期合并临床或亚临床甲状腺功能减退症（甲减）和甲状腺自身抗体阳性与早产发生风险的关系.方法 计算机检索PubMed数据库、EMBASE数据库、万方医学数据库、中国生物医学文献数据库和中国学术期刊网络出版总库,收集1980年1月1日至2013年12月31日期间发表的相关文献,中文检索词为甲状腺功能减退、亚临床甲状腺功能减退、低甲状腺素血症、甲状腺自身抗体、早产、队列研究等.英文检索词为hypothyroidism、subclinical hypothyroidism、hypothyroxinnism、thyroid antibody、pretermlabor、preterm birth等.（1）纳入标准：研究设计为临床研究,研究病例数≥10例;暴露为临床或亚临床甲减、低甲状腺素血症、甲状腺自身抗体阳性,目标事件为早产.（2）排除标准：临床研究病例数少于10例的文献,对照组不是甲状腺功能正常的孕妇.采用RevMaa 5软件进行荟萃分析,妊娠合并临床或亚临床甲减的例数、甲状腺自身抗体阳性的例数、早产事件发生率等计数资料以OR值或RR值作为分析的统计量.结果 （1）共纳入20篇队列研究文献,总队列例数498 418例,累计发生早产39 596例;20篇文献的对照组均为甲状腺功能正常的孕妇.（2）妊娠合并临床甲减：有8个研究被纳入,共计478418例孕妇,妊娠合并临床甲减孕妇5 473例,对照组孕妇472 945例.荟萃分析结果显示,妊娠合并临床甲减孕妇早产的发生风险明显高于对照组（OR=1.25,95％ CI为1.15～1.36,P＜0.01）.（3）妊娠合并亚临床甲减：有10个研究被纳入,共277 531例妊娠,妊娠合并亚临床甲减孕妇5 257例,对照组孕妇272 274例.荟萃分析结果显示,妊娠合并亚临床甲减孕妇发生早产的风险明显高于对照组（OR=1.25,95％ CI为1.14～1.36,P＜0.01）.（4）妊娠合并甲状腺自身抗体阳性：有11个研究被纳入,共28 781例妊娠,妊娠合并甲状腺自身抗体阳性孕妇3 036例,对照组�Objective To evaluate the relationship between clinical or subclinical hypothyroidism and positive thyroid autoantibody before 20 weeks pregnancy and risk of preterm birth. Methods Literature search was done in PubMed, EMBASE, Wanfang Medical Database, China Academic Journal Network Publishing Database and China Biology Medicine disc databases from January 1st, 1980 to December 31th, 2013. The following search terms were used：hypothyroidism, subclinical hypothyroidism, hypothyroxinnism, thyroid antibody, preterm labor, preterm birth, etc. （1） Criteria for inclusion： cohort studies and clinical studies were included; only articles that described at least 10 patients were eligible; the exposure was clinical or subclinical hypothyroidism and positive thyroid autoantihody, and outcome was preterm birth. （2） The excluded subjects were articles that described less than 10 patients; controls were pregnant women without eurothyrodisim. Meta-analysis was performed by RevMan 5. The relationship between clinical or subclinical hypothyroidism and positive thyroid autoantibody and risk of preterm birth was evaluated by OR or RR. Results （1） Twenty cohort studies were enrolled. A total of 39 596 cases of preterm birth occurred among 498 418 pregnant women. The controls in these studies were pregnant women with eurothyrodisim. （2） Clinical hypothyroidism in pregnancy： eight studies were included, reported data on 478 418 pregnant women （5 473 women with clinical hypothyroidism and 472 945 euthyroid pregnant women）. The risk of preterm birth in pregnant women with clinical hypothyroidism was higher than those enrothyroid pregnant women in control group （OR=1.25,95% CI：1.15-1.36, P〈0.01）. （3） Subclinical hypothyroidism in pregnancy： ten studies were included, reported data on 277 531 pregnant women （5 257 women with subclinical hypothyroidism and 272 274 euthyroid pregnant women）. The risk of preterm birth in pregnant women with subclinical hypothyroidism was higher than those in contro

关 键 词：妊娠初期 甲状腺功能减退症 早产 甲状腺 自身抗体 危险因素 Meta分析 

分 类 号：R714.256[医药卫生—妇产科学] R714.21[医药卫生—临床医学]