左旋甲状腺素对单纯甲状腺自身抗体阳性孕妇流产风险的荟萃分析

    Effects of Levothyroxine on The Risk of Miscarriage in Pregnant Euthyroid Women with Thyroid Autoantibody-Positive: A Meta-Analysis

    • 摘要: 目的 探讨左旋甲状腺素治疗对甲状腺功能正常单纯甲状腺自身抗体阳性孕妇流产的影响。 方法 以“甲状腺自身免疫”、“流产”和“甲状腺素”为关键词,计算机联机检索PubMed、Cochrane图书馆、EMBASE、中国知网以及万方医学网等数据库并辅以手工检索。收集2000年 1月至2019年4月关于单纯甲状腺自身抗体阳性孕妇经左旋甲状腺素治疗的前瞻性及回顾性研究文献,按纳入及排除标准筛选文献,并采用Newcastle-Ottawa-Scale(NOS)文献质量评价量表对纳入的文献进行质量评价。采用 RevMan 5.3软件进行荟萃分析。 结果 (1)本研究共纳入7篇文献,6篇为队列研究,1篇为病例对照研究,均为英文文献。NOS量表评分结果,6篇文献为7~9分高质量文献,1篇为6分中等质量文献。(2)荟萃分析显示,单纯甲状腺自身抗体阳性的孕妇经左旋甲状腺素治疗发生流产风险的比值比为0.80,95%可信区间为0.59~1.09,P=0.15。 结论 使用左旋甲状腺素不降低单纯甲状腺自身抗体阳性孕妇的流产风险。

       

      Abstract: Objective To investigate the effect of levothyroxine (LT4) treatment on abortion in euthyroid women with positive thyroid autoantibodies(TAI). Methods Three groups of keywords related to “thyroid autoimmune”, “abortion” and “thyroid hormone” were searched online or by hand. Data were searched among PubMed, EMBASE, Cochrane Library, Wanfang medical database,CNKI from January 2000 to April 2019. Collection of prospective and retrospective literatures on LT4 treatment of euthyroid pregnant women with positive thyroid autoantibodies. Quality of the extracted literature were evaluated by Newcastle- Ottawa-Scale (NOS). Meta- analysis was performed by RevMan 5.3 software. Results (1) The study included 7 articles, 6 were cohort studies, and 1 was a case-control study. All of them were English literatures. NOS score results: 6 were rated 7~9 points (for high-quality literature). 1 was rated 6 points (for medium-quality literature). (2) The meta-analysis showed that the odds ratio value of miscarriage risk for TAI pregnant women treated with LT4 was 0.80, 95% confidence interval was 0.59~1.09, P=0.15. Conclusion LT4 does not reduce the risk of a miscarriage in pregnant women with TAI with intact thyroid function.

       

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