摘要
目的：探讨孕妇甲状腺自身免疫状态与早产发生风险的关系。方法计算机检索PubMed数据库、Embase数据库、万方医学网数据库、中国生物医学文献数据库（CBM）和中国学术期刊网络出版总库（CAJD），收集1980年1月1日至2015年7月31日期间发表的相关文献。（1）按纳入及排除标准提取文献，并采用Newcastle-Ottawa Scale（NOS）文献质量评价表的评价标准对所提取的文献进行质量评价。（2）采用Cochrane图书馆数据库制定的RevMan 5软件进行荟萃分析，先对各个研究进行异质性检验，根据检验结果选用效应模型（包括固定效应模型、随机效应模型）进行合并分析。本研究将甲状腺过氧化物酶抗体（TPO-Ab）和甲状腺球蛋白抗体（TG-Ab）两个指标均阳性的孕妇定义为甲状腺抗体阳性孕妇，仅TPO-Ab阳性的孕妇定义为TPO-Ab阳性孕妇，然后分别研究这两类抗体阳性与早产风险的关系。结果（1）共纳入10篇队列研究文献，NOS量表评分均≥7分，均为高质量及中等质量文献。共纳入孕妇19910例，其中早产1322例。（2）荟萃分析显示，甲状腺功能正常的孕妇其甲状腺抗体阳性不增加早产的发生风险，OR=1.41，95%CI为0.83～2.40（P=0.200）；甲状腺功能减退的孕妇其甲状腺抗体阳性不增加早产的发生风险，OR=0.68，95%CI为0.32～1.44（P=0.310）。甲状腺功能正常的孕妇其TPO-Ab阳性明显增加早产的发生风险，OR=2.08，95%CI为1.09～3.97（P=0.030）；甲状腺功能减退的孕妇其TPO-Ab阳性不增加早产的发生风险，OR=1.21，95%CI为0.65～2.24（P=0.550）。结论妊娠合并TPO-Ab阳性是甲状腺功能正常孕妇发生早产的危险因素。
Objective To evaluate the relationship between thyroid autoimmunity and the risk of preterm birth. Methods Literature search was done among PubMed, Embase, Wanfang Medical Database, China Academic Journal Network Publishing Database and China Biology Medicine disc from Jan. 1st 1980 to July 31st, 2015. （1） Literature were extracted according to inclusion and exclusion standards, and the quality of the extracted literature were evaluated by Newcastle-Ottawa Scale （NOS）. （2） Meta-analysis was performed by RevMan 5 software formulated by using the Cochrane library databases. Various heterogeneity of the research was inspected firstly. According to the results of the inspection a certain effect model was selected （including fixed effects model, the random effects model） to be utilized in merger analysis. In this study pregnant women with both thyroid peroxidase antibodies （TPO-Ab） and thyroglobulin （TG-Ab） positive were defined as thyroid antibody positive pregnant women. Pregnant women with only TPO-Ab positive were defined as TPO-Ab positive pregnant women. Then the relationship of antibody positive and the risk of a pre-term birth was analyzed respectively. Results （1） Ten cohort studies were enrolled, of which NOS scale score were 7 or higher. All the studies are of medium quality and above. A total of 1 322 cases of preterm birth occurred among 19 910 pregnant women. （2） Positive thyroid autoantibodies did not increase the risk of preterm birth in euthyroid pregnant women （OR=1.41, 95%CI：0.83-2.40, P=0.200） or in pregnant women＆amp;nbsp;with hypothyroidism （OR=0.68, 95%CI： 0.32-1.44, P=0.310）. Positive TPO-Ab in euthyroid pregnant women increase the risk of preterm birth significantly （OR=2.08, 95%CI：1.09-3.97, P=0.030）, but positive TPO-Ab in pregnant women with hypothyroidism did not increase the risk of preterm birth significantly （OR=1.21, 95%CI：0.65-2.24, P=0.550）. Conclusion Positive TPO-Ab is an independent risk factor of preterm birth in euthyroid pregnant women.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2016年第5期339-344,共6页
Chinese Journal of Obstetrics and Gynecology
基金
国家自然科学基金（81302277）
关键词
妊娠并发症
甲状腺
自身抗体
自身免疫
早产
Meta分析
Pregnancy complications
Thyroid gland
Autoantibodies
Autoimmunity
Premature birth
Meta-analysis
