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自身免疫性甲状腺疾病对怀孕结果的影响:系统性审查和元分析
Anwar A Sayed1, Maryam Mohammed Abdulaal2, Elaf Mohammed Emam2
1Department of Basic Medical Sciences, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia.
Journal of clinical medicine
|December 11, 2025
概括
孕妇自身免疫性甲状腺疾病 (AITD) 会增加早产的风险. 在高危人群中,Levothyroxine (LT4) 治疗可能会减少流产和早产.
科学领域:
- 内分泌学 在内分泌学.
- 生殖医学 生殖医学
- 免疫学 免疫学 免疫学
背景情况:
- 甲状腺自身免疫性疾病 (AITD) 在生殖年龄的女性中很普遍,以甲状腺自身抗体 (TPOAbs,TgAbs) 为标志.
- 对AITD对怀孕结果的具体影响仍然不完全理解,尽管建议与母亲和新生儿不良事件的关联.
- 关键的自身抗体包括甲状腺过氧化酶抗体 (TPOAbs) 和甲状腺球蛋白抗体 (TgAbs).
研究的目的:
- 评估AITD与不良妊娠结果之间的关联.
- 评估莱沃西 (LT4) 治疗在高风险人群中减轻这些风险的疗效.
- 综合随机对照试验 (RCT) 关于AITD和怀孕的证据.
主要方法:
- 在PubMed和Web of Science进行了系统的文献搜索,遵守PRISMA指南.
- 包括的研究是以AITD诊断的妇女怀孕结果为重点的RCT.
- 分析的主要结果是早产,流产和活产率,其次要结果包括孕产妇和新生儿并发症.
主要成果:
- 分析了8项涉及TPOAb阳性女性 (甲状腺上下或亚临床甲状腺功能低下症) 的RCT.
- AITD与早产风险增加有显著的联系 (合并 OR 3.92).
- 利沃甲氧氨酸 (LT4) 治疗显著降低了流产 (合并OR0.52) 和早产 (合并OR0.37) 的风险.
结论:
- 自身免疫性甲状腺疾病 (AITD) 与怀孕期间早产风险增加有关.
- 利沃甲氧氨酸 (LT4) 治疗显示出降低有潜力的流产和早产率在高风险的妇女与AITD.
- 未来的研究应该根据AITD亚型,抗体水平和甲状腺功能对结果进行分层分类,以便更精确地了解围产期风险.
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