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Updated: Jun 29, 2025

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怀孕时甲状腺功能障碍的危险因素:个体参与者数据元分析
Joris A J Osinga1,2, Yindi Liu1,2, Tuija Männistö3
1Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
概括
目前孕期甲状腺功能障碍的风险因素具有较差的预测能力. 甲状腺过氧化酶抗体 (TPOAb) 阳性是甲状腺功能低下症的重要危险因素,这表明它在向查中的有用性.
科学领域:
- 内分泌学 在内分泌学.
- 生殖医学 生殖医学
- 临床流行病学临床流行病学
背景情况:
- 国际指导方针提倡对妊娠时甲状腺功能障碍进行有针对性的查.
- 目前用于查的风险因素表明歧视能力有限.
- 在怀孕期间准确识别甲状腺功能障碍对于母亲和胎儿的健康至关重要.
研究的目的:
- 量化甲状腺功能测试异常与当前国际指南中使用的特定风险因素相关的风险.
- 评估妊娠时甲状腺功能障碍常用的风险因素的预测价值.
- 为有针对性的查确定更可靠的指标.
主要方法:
- 前性队列研究包括关于母亲甲状腺功能和风险因素 (年龄,BMI,平价,吸烟,试管婴儿,双胞胎怀孕,妊娠年龄,教育,抗体) 的数据.
- 排除具有先前存在的甲状腺疾病或甲状腺干扰药物的参与者.
- 使用混合效应回归模型分析个人参与者数据,以确定主要结局 (明显/亚临床甲状腺功能低下症,治疗指示).
主要成果:
- 这项研究包括25个队列中的65,559名参与者.
- 通常推的风险因素 (年龄>30,平价≥2,BMI≥40) 的预测能力低 (AUC0.58-0.63).
- 甲状腺过氧化酶抗体 (TPOAb) 的阳性显著增加了甲状腺功能低下的风险 (例如,公开的综合阳性风险为7.0%,亚临床的20.0%). 双胞胎怀孕与较高的明显甲状腺功能障碍风险 (5.6%与0.7%) 有关.
结论:
- 评估的风险因素具有较差的预测能力,质疑它们对针对性妊娠甲状腺功能障碍查的临床有用性.
- 甲状腺过氧化酶抗体 (TPOAb) 阳性已成为妊娠期间甲状腺功能低下的相关和显著危险因素.
- 研究结果表明,需要重新评估目前的查策略,并更加突出地考虑抗体状况.
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