摘要
目的 系统评价左旋甲状腺素(levothyroxine,L-T4)干预与否对抗甲状腺过氧化物酶抗体(anti-thyroid peroxidase antibody,TPOAb)阴性的亚临床甲状腺功能减退(subclinical hypothyroidism,SCH)孕妇发生早产风险的影响。方法 检索PubMed、荷兰医学文摘(Excerpta Medica Database,EMBASE)数据库、Web of Science、考克兰图书馆(the Cochrane Library)、维普、中国知网、万方和中国生物医学文献数据库,收集自建库至2021-09-20日期间发表的关于L-T4干预TPOAb阴性SCH孕妇与早产风险的文献。应用RevMan 5.3软件进行Meta分析。结果 (1) TPOAb阴性SCH孕妇是发生早产的危险因素(OR=2.41,95%CI:1.46~3.99,P<0.05);(2)TPOAb阴性SCH未干预组孕妇发生早产的风险是干预组的2.40倍(OR=2.40,95%CI:1.43~4.03,P<0.05);(3)TPOAb阴性SCH孕妇与甲功正常组的早产发生情况无统计学差异(OR=1.16,95%CI:0.81~1.66,P=0.41);(4)按照促甲状腺激素(thyroid stimulating hormone,TSH)参考值上限切割点进行亚组分析显示,2.5<TSH≤4.0 mIU/L,TPOAb阴性SCH干预组与未干预组孕妇早产发生情况无统计学差异(OR=2.12,95%CI:0.93~4.85,P=0.07);TSH>4.0 mIU/L,TPOAb阴性SCH未干预组发生早产的风险是干预组孕妇的30.67倍(OR=30.67,95%CI:2.09~449.01,P<0.05)。结论 TPOAb阴性妊娠期SCH会增加早产的发生风险;L-T4干预治疗可以明显降低早产的发生风险;当TSH<4.0 mIU/L时,TPOAb阴性SCH孕妇L-T4治疗与否对早产发生风险无显著影响;当TSH>4.0 mIU/L,TPOAb阴性SCH孕妇需要L-T4积极治疗。
Objective To systematically evaluate the effects of levothyroxine(L-T4) intervention or not on the risk of preterm delivery in subclinical hypothyroidism(SCH) pregnant women with anti-thyroid peroxidase antibody(TPOAb) negativity.Methods The databases such as PubMed,Excerpta Medica Database(EMBASE),Web of Science,the Cochrane Library,Vipshop,China national knowledge infrastructure(CNKI),Wanfang and China Biomedical Literature were searched,and the literature on L-T4 intervention in TPOAb negative pregnant women with SCH and the risk of preterm delivery published from the construction date of database to September 20,2021 were collected.Meta-analysis was performed by RevMan 5.3 software.Results(1) Pregnant women with TPOAb negative gestational SCH were risk factors for developing preterm delivery(OR=2.41,95%CI:1.46-3.99,P<0.05);(2) The risk of preterm delivery was 2.40 times higher in the TPOAb negative SCH non-intervention group than in the intervention group(OR=2.40,95%CI:1.43-4.03,P<0.05);(3) There was no significant difference in the incidence of preterm delivery between the TPOAb-negative gestational SCH pregnant women and the normal thyroid function group(OR=1.16,95% CI:0.81-1.66,P=0.41);(4) Subgroup analysis according to the upper cut point of thyroid stimulating hormone(TSH) reference value showed that 2.5<TSH≤4.0 mIU/L.There was no significant difference in the occurrence of preterm delivery between the intervention and non-intervention groups in TPOAb negative pregnancy(OR=2.12,95%CI:0.93-4.85,P=0.07);with TSH>4.0 mIU/L,the risk of preterm delivery in the non-intervention group of TPOAb negative SCH was 30.67 times higher than that in the intervention group(OR=30.67,95%CI:2.09-449.01,P<0.05).Conclusion TPOAb negative SCH increases the risk of preterm delivery;L-T4 intervention treatment significantly reduces the risk of preterm delivery;when TSH<4.0 mIU/L,TPOAb negative gestational SCH pregnant women with or without L-T4 treatment has no significant effect on the risk of preterm delivery;TPOAb negative gestational SCH pregnant women need L-T4 active treatment is required when TSH>4 mIU/L.
作者
杨燕
谢军
YANG Yan;XIE Jun(Medical Colleage,Department of Wuhan University of Science and Technology,Wuhan Hubei 430000,China)
出处
《华南国防医学杂志》
CAS
2022年第3期202-207,共6页
Military Medical Journal of South China
