Poppe Kris, Glinoer Daniel, Tournaye Herman, Devroey Paul, van Steirteghem Andre, Kaufman Leonard, Velkeniers Brigitte
Department of Endocrinology, Vrije Universiteit Brussel, Brussels 1090, Belgium.
J Clin Endocrinol Metab. 2003 Sep;88(9):4149-52. doi: 10.1210/jc.2003-030268.
The association between positive thyroid antibodies and an increased miscarriage rate in pregnancies after assisted reproduction technology (ART) remains controversial. We wanted to clarify this issue by performing a prospective cohort study in 234 women by systematically screening for thyroid peroxidase antibodies (TPO-Ab), serum TSH, and free T(4)(FT(4)) before the first ART cycle. Women with overt thyroid dysfunction were excluded. Fourteen percent of the cohort had positive TPO-Ab. Baseline characteristics [age, 33 +/- 5 yr; TSH, 1.6 (0.02-4.1) mU/liter; and FT(4), 12.2 (9.1-18) ng/liter] were comparable to those of the 86% of women without antibodies [age, 32 +/- 5 yr; TSH, 1.3 (0.05-3.6) mU/liter; and FT(4), 11.7 (9.5-16.5) ng/liter]. In the antibody-positive group, the pregnancy rate was 53% vs. 43% in the antibody-negative group, with an odds ratio of 0.67 [95% confidence interval (CI) (0.32-1.41); P = not significant]; however within the group that was pregnant, the miscarriage rate was 53% and 23%, respectively, with an odds ratio of 3.77 [95% CI (1.29-11.05); P = 0.016]. The age of the women was an independent risk factor for miscarriage, odds ratio 1.08 [95% CI (1.03-1.15); P = 0.005]. We conclude that women with positive TPO-Ab before the first ART cycle have a significantly increased risk for miscarriage.
在辅助生殖技术（ART）后的妊娠中，甲状腺抗体阳性与流产率升高之间的关联仍存在争议。我们通过在234名女性中进行前瞻性队列研究来阐明这一问题，在第一个ART周期前系统筛查甲状腺过氧化物酶抗体（TPO-Ab）、血清促甲状腺激素（TSH）和游离甲状腺素（FT4）。排除明显甲状腺功能障碍的女性。该队列中14%的女性TPO-Ab呈阳性。基线特征[年龄，33±5岁；TSH，1.6（0.02 - 4.1）mU/升；FT4，12.2（9.1 - 18）ng/升]与86%抗体阴性女性的特征[年龄，32±5岁；TSH，1.3（0.05 - 3.6）mU/升；FT4，11.7（9.5 - 16.5）ng/升]相当。在抗体阳性组中，妊娠率为53%，而抗体阴性组为43%，优势比为0.67[95%置信区间（CI）（0.32 - 1.41）；P = 无显著差异]；然而，在已怀孕的组中，流产率分别为53%和23%，优势比为3.77[95% CI（1.29 - 11.05）；P = 0.016]。女性年龄是流产的独立危险因素，优势比为1.08[95% CI（1.03 - 1.15）；P = 0.005]。我们得出结论，在第一个ART周期前TPO-Ab阳性的女性流产风险显著增加。
