控制性超促排卵技术对亚临床甲状腺功能减退患者甲状腺功能的影响  

Effects of controlled ovarian hyperstimulation on thyroid function in infertile subclinical hypothyroidism women

作　　者：蔡芸莹[1] 钟兰萍[2] 武泽[2] 苏恒[1] Cai Yunying;Zhong Lanping;Wu Ze;Su Heng(Department of Endocrinology,the First People's Hospital of Yunnan Province,the Affiliated Hospital of Kunming University of Science and Technology,Kunming 650032,China;Reproductive Center of the First People's Hospital of Yunnan Province,the Affiliated Hospital of Kunming University of Science and Technology,Kunming 650032,China)

机构地区：[1]云南省第一人民医院,昆明理工大学附属医院内分泌代谢科,昆明650032 [2]云南省第一人民医院,昆明理工大学附属医院生殖医学中心,昆明650032

出　　处：《中华生殖与避孕杂志》2022年第7期675-681,共7页Chinese Journal of Reproduction and Contraception

基　　金：国家自然科学基金项目(81760143);云南省卫生和计划生育委员会医学领军人才培养项目(L-201624);云南省万人计划“名医”专项(YNWR-MY-2019-020);云南省科技厅科技计划项目(U0120170150)。

摘　　要：目的探讨控制性超促排卵(controlled ovarian hyperstimulation,COH)对左旋甲状腺素(levothyroxine,LT4)替代治疗的亚临床甲状腺功能减退症(subclinical hypothyroidism,SCH)不孕妇女甲状腺功能的影响。方法回顾性队列研究分析于2015年1月至2017年3月期间在云南省第一人民医院生殖医学中心行体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection and embryo transfer,IVF/ICSI-ET)助孕治疗的SCH不孕妇女(已接受LT4替代治疗)。最终纳入124例患者COH治疗前后的配对甲状腺功能数据进入统计分析。根据基线时血清促甲状腺素(thyroid stimulating hormone,TSH)控制水平,分为0.2 mU/L≤TSH≤2.5 mU/L组(n=88)和2.5 mU/L<TSH≤4.2 mU/L组(n=36);根据首次IVF是否获得临床妊娠,分为临床妊娠组(n=72)及未妊娠组(n=52);根据基线时甲状腺过氧化物酶抗体和(或)甲状腺球蛋白抗体是否为阳性,分为甲状腺自身抗体(thyroid autoantibody,ATA)阳性组(n=76)及ATA阴性组(n=48)。入组者接受本中心常规进行的COH方案,于卵泡刺激前、人绒毛膜促性腺激素(human chorionic gonadotrophin,hCG)注射日以及胚胎移植后14 d行TSH、甲状腺激素及ATA检测(电化学发光法),分析IVF临床结局。结果COH对接受LT4替代治疗的SCH不孕妇女的甲状腺功能有显著影响,基线时、hCG注射日、胚胎移植后14 d的TSH分别为1.75(0.43,2.57)mU/L、1.03(0.37,2.35)mU/L、4.27(1.13,6.88)mU/L,组间比较差异均有统计学意义(均P<0.001)。胚胎移植后14 d,基线时0.2 mU/L≤TSH≤2.5 mU/L组40.9%(36/88)的患者TSH>4.2 mU/L,2.5 mU/L<TSH≤4.2 mU/L组COH后77.8%(28/36)的患者TSH>4.2 mU/L。IVF/ICSI-ET后14 d时,临床妊娠组的TSH水平显著高于未妊娠组[6.09(2.18,9.09)mU/L比1.84(0.62,4.45)mU/L,P=0.002]。与ATA阴性组相比,ATA阳性组COH后TSH水平升高幅度更显著(P=0.013)。结论COH可导致已接受LT4替代治疗的SCH不孕妇女TSH水平升高,变化幅度与基�Objective To investigate the impact of controlled ovarian hyperstimulation(COH)on thyroid function in infertile subclinical hypothyroidism(SCH)women treated with levothyroxine(LT4).Methods A cohort study included LT4 treated infertile SCH patients undergoing in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)from January 2015 to March 2017 in the Reproductive Center of the First People's Hospital of Yunnan Province were retrospectively analyzed.Finally,the paired thyroid hormone data of 124 patients before and after COH were included for statistical analysis.According to baseline thyroid stimulating hormone(TSH)level,women were divided into 0.2 mU/L≤TSH≤2.5 mU/L group(n=88)and 2.5 mU/L<TSH≤4.2 mU/L group(n=36).Patients were divided into clinical pregnancy group(n=72)and non-pregnancy group(n=52)according to their first IVF outcomes.According to basal line thyroid peroxidase antibody and/or thyroglobulin antibody(ATA)levels,patients were classified into ATA positive group(n=76)and ATA negative group(n=48).The patients received COH routinely performed by our center,and TSH,thyroid hormone and ATA tests(electrochemiluminescence)were performed before follicular stimulation,on the day of human chorionic gonadotrophin(hCG)injection and 14 d after ET.IVF outcomes were analyzed.Results COH had a significant effect on thyroid function in LT4 treated SCH patients undergoing IVF.Serum levels of TSH before COH,the time of hCG injection and the 14th day after ET were 1.75(0.43,2.57)mU/L,1.03(0.37,2.35)mU/L and 4.27(1.13,6.88)mU/L(all P<0.001),respectively.At the 14th day after ET,compared with lower baseline TSH group(0.2 mU/L≤TSH≤2.5 mU/L),the higher baseline TSH group(2.5 mU/L<TSH≤4.2 mU/L)had a significant rise in TSH[proportion of TSH>4.2 mU/L,77.8%(28/36)vs.40.9%(36/88),P<0.001].At the 14th day after ET,the TSH level in the clinical pregnancy group was significantly higher than that in the non-pregnancy group[6.09(2.18,9.09)mU/L vs.1.84(0.62,4.45)mU/L,P=0.002].The incremen

关 键 词：控制性超促排卵 亚临床甲状腺功能减退 甲状腺功能 

分 类 号：R581.2[医药卫生—内分泌]