甲状腺自身免疫性抗体与不孕女性卵巢储备功能的关联性研究  

Association between thyroid-associated antibodies and ovarian reserve in infertile women:a clinical study of 526 cases

作　　者：卜晓萌 刘艳君[1,2] 张巧利 贾婵维[1,2] 马延敏 李莘[3] BU Xiaomeng;LIU Yanjun;ZHANG Qiaoli;JIA Chanwei;MA Yanmin;LI Xin(Department of Reproductive Medicine,Beijing Gynaecology and Obstetrics Hospital,Capital Medical University,Beijing,100026;Department of Reproductive Medicine,Beijing Maternal and Child Health Care Hospital,Beijing,100026;Department of Anesthesiology,North Beijing Medical Branch,Chinese PLA General Hospital,Beijing,100096,China)

机构地区：[1]首都医科大学附属北京妇产医院生殖医学科,北京100026 [2]北京妇幼保健院生殖医学科,北京100026 [3]解放军总医院京北医疗区麻醉科,北京100096

出　　处：《陆军军医大学学报》2024年第20期2330-2336,共7页Journal of Army Medical University

基　　金：妇幼健康基金会基金项目(2022AMCHS002)。

摘　　要：目的比较不同卵巢储备功能不孕女性甲状腺自身免疫性抗体阳性率的差异,寻找与卵巢储备功能减退的相关免疫因素。方法采用病例-对照研究设计方案,收集2020年6-12月在北京妇产科医院生殖医学科就诊的不孕患者,检测纳入的526例不孕患者抗苗勒氏管激素(anti-Müllerian hormone,AMH)、促甲状腺素(thyroid stimulating hormone,TSH)、甲状腺球蛋白抗体(thyroglobulin antibody,TGAb)和甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb);根据AMH水平(>1.1 ng/mL和≤1.1 ng/mL),将患者分为卵巢储备正常组和卵巢储备减退组,并进行年龄分层(25~30岁,>30~35岁,>35~40岁),比较不同卵巢储备患者的TSH、TGAb和TPOAb的差别,分析卵巢储备功能减退降低的关联因素。结果在单因素分析中显示卵巢储备减退组患者的TPOAb(18.8%vs 11.1%,P=0.024)和TGAb(18.8%vs 8.0%,P=0.001)阳性率较高,存在显著性差异。多因素Logistic回归分析提示年龄、TGAb阳性和卵巢储备减退有关联[OR=1.083(95%CI:1.021~1.150),P=0.008;OR=1.159(95%CI:1.034~1.301),P=0.011]。亚组分析显示,在>35~40岁年龄组中,TGAb阳性及TPOAb阳性与AMH分组的存在显著相关性(P<0.05)。结论卵巢储备功能减退的不孕女性TGAb和TPOAb较高,>35~40岁不孕女性的卵巢储备功能减退可能与TGAb及TPOAb阳性相关。ObjectiveTo compare the positive rate of thyroid autoantibodies in infertile women with different ovarian reserve function,and investigate the immune factors of diminished ovarian reserve.MethodsA cross-sectional study was conducted on infertile women admitted to Department of Reproductive Medicine of Beijing Gynaecology and Obstetrics Hospital from June to December,2020.The levels of anti-Müllerian hormone(AMH),thyroid stimulating hormone(TSH),thyroglobulin antibody(TGAb)and thyroid peroxidase antibody(TPOAb)were detected in the 526 enrolled infertile patients.According to their AMH level,they were divided into normal ovarian reserve group and diminished ovarian reserve group.After they were stratified according to their age,the differences of TSH,TGAb and TPOAb levels were compared in the different age groups to analyze the related factors for diminished ovarian reserve.ResultsUnivariate analysis showed that the diminished ovarian reserve group had significantly higher positive rates of TPOAb(18.8%vs 11.1%,P=0.024)and TGAb(18.8%vs 8.0%,P=0.001)than the normal ovarian reserve group.Multivariate logistic regression analysis indicated that age and TGAb positivity were related to diminished ovarian reserve[OR=1.083(95%CI:1.021~1.150),P=0.008;OR=1.159(95%CI:1.034~1.301),P=0.011].Subgroup analysis suggested that the positive TGAb and TPOAb were significantly correlated with AMH level in the 36-~40-year-old group(P<0.05).ConclusionThe infertile women with diminished ovarian reserve have higher TGAb and TPOAb levels,and the diminishment in those aged 36~40 years might be related to the positive TGAb and TPOAb.

关 键 词：不孕 卵巢储备 甲状腺过氧化物酶抗体 抗苗勒管激素 

分 类 号：R343.23[医药卫生—基础医学] R730.23R737.25