甲状腺自身免疫增加不明原因复发性流产人群再次妊娠流产的风险  

Thyroid autoimmunity increases the risk of second pregnancy abortion in people with unexplained recurrent abortion

作　　者：王钊睿 冀晓慧 郭义红[2] 梁盈翠 李庄 麦卓瑶 朱梦兰 陈陆静[2] 陈慧[1] Wang Zhaorui;Ji Xiaohui;Guo Yihong;Liang Yingcui;Li Zhuang;Mai Zhuoyao;Zhu Menglan;Chen Lujing;Chen Hui(Reproductive Medicine Center,Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,Guangzhou 510120,China;Dongguan Maternal and Child Health Care Hospital,Dongguan 523120,China)

机构地区：[1]中山大学孙逸仙纪念医院生殖中心,广州510120 [2]东莞市妇幼保健院,东莞523120

出　　处：《中国医师杂志》2024年第11期1607-1612,共6页Journal of Chinese Physician

基　　金：国家重点研发计划(2019YFA0801403);北京健康促进会生殖医学中青年医生研究-临床研究项目(BJHPA-2022-SHZHYXZHQNYJ-LCH-011);广东省自然科学基金(2023A1515010515);广东省自然科学基金(2024A1515013264)。

摘　　要：目的探讨在不明原因复发性流产人群中甲状腺自身免疫与妊娠结局的关系。方法采用回顾性队列研究方法, 纳入2015年1月至2022年6月就诊于中山大学孙逸仙纪念医院甲状腺功能正常的354例不明原因复发性流产患者, 检测其备孕期或孕早期甲状腺抗体和甲状腺功能水平, 根据是否合并甲状腺自身免疫(TAI)分为TAI组(n=144)、非TAI组(n=210)。追踪孕妇妊娠结局。结果与非TAI组相比, TAI组妊娠结局为流产的比例更高[42.4%(61/144) vs 27.1%(57/210), P=0.004]。在不明原因复发性流产人群中, TAI显著增加了自然流产的风险[OR(95%CI):2.13(1.34, 3.41), P=0.001];TPOAb或TgAb阳性也增加了自然流产的风险[OR(95%CI):2.18(1.37, 3.50), P=0.001;OR(95%CI):2.33(1.31, 4.13), P=0.004]。TAI、TPOAb、TgAb与年龄均无显著的交互作用(P=0.482, 0.724, 0.740)。结论在不明原因复发性流产人群中, TAI与自然流产的风险呈现正相关。TAI可能是不明原因复发性流产潜在的危险因素, 拓展了不明原因复发性流产的诊疗思路。Objective To investigate the relationship between thyroid autoimmunity and pregnancy outcome in patients with unexplained recurrent abortion.Methods A retrospective cohort study of 354 patients with normal thyroid function with recurrent abortion of unknown cause admitted to Sun Yat-sen Memorial Hospital,Sun Yat-sen University from January 2015 to June 2022 was used to detect thyroid antibody and thyroid function levels during pregnancy or early pregnancy.They were divided into TAI group(n=144)and non-TAI group(n=210)according to whether thyroid autoimmunity(TAI)was complicated or not.Tracking pregnancy outcomes.Results Compared with the non-TAI group,the TAI group had a higher proportion of pregnancy outcomes resulting in miscarriage[42.4%(61/144)vs 27.1%(57/210),P=0.004].In patients with unexplained recurrent abortion,TAI significantly increased the risk of spontaneous abortion[OR(95%CI):2.13(1.34,3.41),P=0.001].Positive TPOAb or TgAb also increased the risk of spontaneous abortion[OR(95%CI):2.18(1.37,3.50),P=0.001;OR(95%CI):2.33(1.31,4.13),P=0.004].TAI,TPOAb and TgAb had no significant interaction with age(P=0.482,0.724,0.740).Conclusions TAI is positively associated with the risk of spontaneous abortion in patients with unexplained recurrent abortion.TAI may be a potential risk factor for unexplained recurrent abortion,expanding the diagnosis and treatment of unexplained recurrent abortion.

关 键 词：甲状腺自身免疫 甲状腺自身抗体 促甲状腺素 不明原因复发性流产 

分 类 号：R714.21[医药卫生—妇产科学]