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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

杨虹, 莫定雯, 周勇

杨虹, 莫定雯, 周勇. 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[J]. 循证医学, 2019, 19(6): 340-343. DOI: 10.12019/j.issn.1671-5144.2019.06.006
引用本文: 杨虹, 莫定雯, 周勇. 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[J]. 循证医学, 2019, 19(6): 340-343. DOI: 10.12019/j.issn.1671-5144.2019.06.006
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YANG Hong, MO Ding-wen, ZHOU Yong. Effects of Levothyroxine on The Risk of Miscarriage in Pregnant Euthyroid Women with Thyroid Autoantibody-Positive: A Meta-Analysis[J]. Journal of Evidence-Based Medicine, 2019, 19(6): 340-343. DOI: 10.12019/j.issn.1671-5144.2019.06.006
Citation: YANG Hong, MO Ding-wen, ZHOU Yong. Effects of Levothyroxine on The Risk of Miscarriage in Pregnant Euthyroid Women with Thyroid Autoantibody-Positive: A Meta-Analysis[J]. Journal of Evidence-Based Medicine, 2019, 19(6): 340-343. DOI: 10.12019/j.issn.1671-5144.2019.06.006
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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

  • 1.

    海南省人民医院产科, 海口 570311

  • 2.

    海南易建科技股份有限公司, 海口 570125

基金项目: 海南省卫生健康委员会资助项目（1801320311A2001）
详细信息
    作者简介:

    杨虹（1977-）,女,海南文昌人,医学学士,副主任医师,从事妇产科临床工作。

  • 中图分类号: R714.2;R581

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

  • 1.

    Department of Obstetrics, Hainan General Hospital, Haikou 570311, China

  • 2.

    Hainan E-King Technology Company Limited, Haikou 570125, China

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    摘要
  • 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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    • 参考文献(14)
  • [1] STAGNARO-GREEN A, ROMAN S H, COBIN R H,et al.Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies[J]. JAMA, 1990,264(11): 1422-1425.
    [2] THANGARATINAM S, TAN A, KNOX E, et al.Association between thyroid autoantibodies and miscarriage and preterm birth: Meta-analysis of evidence[J]. BMJ, 2011,342: d2616.
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    [6] REVELLI A, CASANO S, PIANE L D, et al.A retrospective study on IVF outcome in euthyroid patients with anti-thyroid antibodies: Effects of Levothyroxine, Acetyl-Salicylic Acid and Prednisolone adjuvant treatments[J]. Reprod Biol Endocrinol, 2009,7: 137.
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    [11] 李旻,王少为,黄帅, 等. 孕妇甲状腺自身免疫状态与早产发生风险关系的荟萃分析[J]. 中华妇产科杂志, 2016, 51(5):339-344.
    [12] 中华医学会内分泌学分会, 中华医学会围产医学分会. 妊娠和产后甲状腺疾病诊治指南[J]. 中华内分泌与代谢杂志, 2015, 28(5): 354-371.
    [13] ALEXANDER E K, PEARCE E N, BRENT G A, et al.2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum[J]. Thyroid, 2017, 27(3): 315-389.
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出版历程
  • 收稿日期:  2019-02-15
  • 发布日期:  2019-12-27

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