Matalon S T, Blank M, Ornoy A, Shoenfeld Y
Center for Autoimmune Diseases, Department of Medicine B Sheba Medical Center, Tel Hashomer, Israel.
Am J Reprod Immunol. 2001 Feb;45(2):72-7. doi: 10.1111/j.8755-8920.2001.450202.x.
The incidence of thyroid autoantibodies in women with recurrent fetal loss, infertility or women who miscarried appears to be increased compared with controls of reproductive age without previous abortions. There are few working hypotheses concerning the asociation between anti-thyroid antibodies and the increased risk for pregnancy loss. The first hypothesis suggests that women with high titers of anti-thyroid antibodies have underlying very mild thyroid "under function". Another theory views the anti-thyroid antibodies as simply secondary markers of a predisposition of autoimmune disease rather than the actual cause of pregnancy loss. An evolutionary explanation suggests that reproductive problems in women with high titers of autoantibodies exist in order to prevent the transmission of autoimmune genes to the next generation. The reason for the association between pregnancy loss and thyroid immunity is still not clear. The working hypotheses above supply multi-factorial explanations, which could act together, may even be in synergy, as the propulsion for the pregnancy loss. Until today the mechanism by which anti Tg are responsible for pregnancy loss is not clear. Induced animal models with high titier of anti Tg could provide direct evidence for the pathogenic role of anti-thyroid antibodies and the mechanism that is responsible for the pregnancy loss in autoimmune thyroiditis. In the current presentation we describe data concerning the association between anti-thyroid antibodies and pregnancy loss, and hypothesis which explains this association.
与无既往流产史的育龄对照组相比,反复流产、不孕或有过流产史的女性中甲状腺自身抗体的发生率似乎有所增加。关于抗甲状腺抗体与流产风险增加之间的关联,目前只有少数可行的假说。第一种假说认为,抗甲状腺抗体滴度高的女性存在潜在的非常轻微的甲状腺“功能减退”。另一种理论则认为,抗甲状腺抗体只是自身免疫性疾病易感性的次要标志物,而非流产的实际原因。一种进化论的解释是,抗甲状腺抗体滴度高的女性出现生殖问题,是为了防止自身免疫基因传递给下一代。流产与甲状腺免疫之间存在关联的原因仍不清楚。上述可行假说提供了多因素解释,这些因素可能共同起作用,甚至可能协同作用,成为流产的诱因。直到今天,抗甲状腺球蛋白导致流产的机制仍不清楚。诱导产生高滴度抗甲状腺球蛋白的动物模型,可以为抗甲状腺抗体的致病作用以及自身免疫性甲状腺炎中导致流产的机制提供直接证据。在本次报告中,我们描述了有关抗甲状腺抗体与流产之间关联的数据,以及解释这种关联的假说。