摘要
目的综合评价甲状腺自身免疫（TAI）与流产的关联性。方法通过文献检索收集2009年3月以前发表的有关甲状腺自身免疫与流产相关性的病例对照研究以及队列研究，剔除不符合要求的文献，以漏斗图检验入选文献的发表偏倚，并根据各入选文献的同质性检验结果进行数据合并，分别计算合并OR值与RR值，应用meta分析软件包RevMan4．3．1进行计算。结果经检索得到23篇文献，剔除综述4篇，余19项临床研究均符合本次meta分析的纳入标准。纳入的19项研究中，7项为病例对照研究，12项为队列研究。7项病例对照研究得到的合并OR值为2．72（95％CI1．27～5．80，P=0．01）；12项队列研究得到的合并RR值为2．41（95％CI1．96～2．96，P〈0．01）。甲状腺自身抗体（TA）阳性妇女较TA阴性者平均年长1．29岁（95％CI0．43～2．16，P=0．003），TA阳性妇女的TSH较TAt阴性者平均高0．61mIU／L（95％CI0．51～0．71，P〈0．01）。结论TAI与流产显著关联。除了TA的直接效应以外，TA阳性孕妇轻度的增龄与甲状腺功能不足亦可能是导致流产风险增加的潜在原因。
Objective To investigate the association between thyroid autoimmunity （TAI） and miscarriage. Methods A systematic review of both ease-control and cohort studies on the association between TAI and miscarriage published before March 2009 was performed. All the literatures were abstracted based on the defined selection criteria by two independent investigators. Publication bias was tested by funnel plot. The odd ratios of case-control studies and relative risks of cohort studies were pooled respectively, depending on the result of heterogeneity test among the individual studies. The software Review Manager （version 4.3.1 ） was used for meta- analysis. Results Electronic search yielded 23 articles, 4 of which were reviews and were excluded. The remaining 19 clinical studies met the selection criteria, of which 7 were case-control studies and 12 cohort studies. A clear association between the presence of thyroid autoantibodies（TA） and miscarriage was found with a pooled odds ratio of 2.72 （95% CI 1.27-5.80, P= 0.01 ） in 7 case-control studies, and a pooled relative risk of 2.41 （95% CI 1.96-2.96, P〈0.01 ） in 12 cohort studies. Women with TA were found to have slightly older age （age difference, 1.29 years, 95% CI0. 43-2.16, P=0. 003） and raised TSH levels （TSH difference, 0.61 mIU/L, 95% CI 0. 51-0.71, P〈0.01 ） compared with those without TA. Conclusion TAI is significantly associated with miscarriage, which can be interpreted as the direct involvement of TA. Alternatively, the association can be partially explained by the slightly older age in women with TA compared with those without. A third possibility is mild thyroid failure, as TSH levels in TA-positive but euthyroid women are higher than in TA-negative women.
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2010年第3期203-208,共6页
Chinese Journal of Endocrinology and Metabolism
