左旋甲状腺素片对甲状腺功能正常伴TPO-Ab阳性孕妇的流产率及早产率影响的meta分析  

Effect of levothyroxine on abortion rate and preterm birth rate in pregnant women with thyroid autoimmunity and normal thyroid function:a systematic review and meta-analysis

作　　者：冯铿 杨一华 罗宇迪[1] 朱玲玲[1] 刘博[2] 韦植耀 邓荣 文秋月 贲银 覃爱平[2] Feng Keng;Yang Yihua;Luo Yudi;Zhu Lingling;Liu Bo;Wei Zhiyao;Deng Rong;Wen Qiuyue;Ben Yin;Qin Aiping(Reproductive Medicine Center,Yulin Maternal and Child Health Hospital,Yulin 537000,China;Reproductive Medicine Center,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]玉林市妇幼保健院生殖中心,玉林537000 [2]广西医科大学第一附属医院生殖中心,南宁530021

出　　处：《中华生殖与避孕杂志》2022年第7期717-723,共7页Chinese Journal of Reproduction and Contraception

摘　　要：目的系统评价口服左旋甲状腺素片对甲状腺功能正常伴甲状腺过氧化物酶抗体(antithyroid peroxidase-antibody,TPO-Ab)阳性[即自身免疫性甲状腺炎(thyroid autoimmunity,TAI)]孕妇流产率及早产率的影响。方法计算机检索Pubmed、Cochrane、中国生物医学文献数据库、CNKI、维普、万方等中英文数据库,系统性搜索口服左旋甲状腺素片治疗TAI孕妇的相关研究,检索时限为建库至2020年8月。由2名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险,采用Revman5.3软件进行meta分析。结果①本研究最终纳入6篇文献,均为随机对照试验(randomized controlled trial,RCT)研究,共计1427例患者;②与对照组相比,口服左旋甲状腺素片不能降低TAI孕妇的早产率和流产率;③进一步按照受孕方式将数据进行亚组分析后显示,自然妊娠的TAI孕妇口服左旋甲状腺素片可有效降低早产率(RR=0.54,95%CI=0.31~0.95,P=0.03),但不能降低孕妇流产率(RR=0.86,95%CI=0.69~1.06,P=0.15)。辅助生殖受孕的TAI孕妇口服左旋甲状腺素片不能降低流产率(RR=0.80,95%CI=0.47~1.36,P=0.41)。结论口服左旋甲状腺素片不能降低TAI孕妇的流产率,但可以降低自然受孕的TAI孕妇早产的风险,无法评价是否能降低辅助生殖受孕的TAI孕妇早产率。因此自然受孕的TAI妇女孕期可以起始予25~50μg/d的左旋甲状腺素片治疗,而辅助生殖受孕的TAI妇女口服左旋甲状腺素片不能获益。建议临床上将两组患者分开管理,并告知患者治疗的局限性,避免过高的期望值。Objective To evaluate the efficacy of oral levothyroxine on abortion rate and preterm birth rate in pregnant women with thyroid autoimmunity(TAI)and normal thyroid function.Methods The relevant studies of oral levothyroxine tablets in the treatment of TAI pregnant women were systematically searched in Pubmed,Cochrane,CBM,CNKI,VIP and Wanfang databases.The retrieval period was established until August 2020.Two researchers independently screened the literatures,extracted the data and evaluated the risk of bias in the included study.Meta-analysis was performed using Revman5.3 software.Results 1)Totally six eligible studies were all randomized controlled studies,involving 1427 patients.2)Compared with control group,the meta-analysis suggests oral levothyroxine tablets cannot effectively reduce the preterm delivery rate and the abortion rate.3)Further subgroup analysis of the data according to the natural pregnancy group and assisted reproduction group found that oral levothyroxine tablets in natural pregnancy women with TAI can effectively reduce the preterm delivery rate(RR=0.54,95%CI=0.31-0.95,P=0.03),but not reduce the abortion rate(RR=0.86,95%CI=0.69-1.06,P=0.15).However,oral levothyroxine tablets cannot reduce the abortion rate for TAI women conceived by reproductive technology(RR=0.80,95%CI=0.47-1.36,P=0.41).Conclusion Oral levothyroxine tablets can effectively reduce the premature delivery rate of TAI women who are naturally pregnant,but it is not beneficial to reduce the abortion rate.There is only one study on TAI women who are pregnant with reproductive technology,so it is impossible to evaluate whether this population can benefit from taking levothyroxine tablets.In view of the above results,it is recommended that the two groups of patients be managed separately.

关 键 词：碘化物过氧化物酶 自身抗体 流产 早产 

分 类 号：R714.256[医药卫生—妇产科学]