Beneventi Fausta, Locatelli Elena, Caporali Roberto, Alpini Claudia, Lovati Elisabetta, Ramoni Véronique, Simonetta Margherita, Cavagnoli Chiara, Montecucco Carlomaurizio, Spinillo Arsenio
Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy.
Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy.
J Reprod Immunol. 2016 Apr;114:32-7. doi: 10.1016/j.jri.2016.02.004. Epub 2016 Mar 2.
To investigate the rates and coexistence of autoimmune thyroid and connective tissue diseases (CTD) during the first trimester of pregnancy and their influence on pregnancy outcome.
A cohort study of 150 women with CTD diagnosed during first trimester of pregnancy and 150 negative controls.
Screening of CTD by a self-reported questionnaire, rheumatic and thyroid autoantibody detection, clinical rheumatological evaluation and obstetric outcomes.
Out of 3852 women screened, 61 (1.6%) were diagnosed with undefined connective tissue disease (UCTD), 28 (0.7%) with major CTD (six rheumatoid arthritis, five systemic lupus erythematosus, eight Sjogren syndrome, five anti-phospholipid syndrome, two systemic sclerosis, one mixed CTD and one monoarticular arthritis) and 61 (1.6%) had insufficient criteria for a diagnosis of a rheumatic disease. The overall prevalence of either thyroid peroxidase (TPO-a) or thyroglobulin (TG-a) autoantibodies detection was 8% (12/150) among controls, 62.3% (38/61) among UCTD and 60.7% (17/28) in women with a major CTD (p<.001 compared to controls for both comparisons). After adjustment for confounders, overall CTDs (major or undefined) (OR=3.54, 95% CI; 1.61-7.78) and TPO-a plus TG-a positivity (OR=2.78, 95% CI;1.29-5.98) were independently associated with increased risks of moderate-severe complications of pregnancy (miscarriage, fetal growth restriction, preeclampsia, delivery before 34 weeks).
Rheumatic and thyroid autoantibodies during pregnancy are closely associated. Thyroid antibodies could add to the risk of adverse pregnancy outcome associated with connective tissue diseases.
调查妊娠早期自身免疫性甲状腺疾病和结缔组织病（CTD）的发病率及其共存情况，以及它们对妊娠结局的影响。
一项队列研究，纳入150例在妊娠早期被诊断为CTD的女性和150例阴性对照。
通过自我报告问卷筛查CTD、检测风湿和甲状腺自身抗体、进行临床风湿学评估以及观察产科结局。
在3852例接受筛查的女性中，61例（1.6%）被诊断为未分化结缔组织病（UCTD），28例（0.7%）被诊断为主要CTD（6例类风湿关节炎、5例系统性红斑狼疮、8例干燥综合征、5例抗磷脂综合征、2例系统性硬化症、1例混合性CTD和1例单关节关节炎），61例（1.6%）不符合风湿性疾病的诊断标准。对照组中甲状腺过氧化物酶（TPO-a）或甲状腺球蛋白（TG-a）自身抗体检测的总体患病率为8%（12/150），UCTD组为62.3%（38/61），主要CTD组女性为60.7%（17/28）（与对照组相比，两次比较的p值均<0.001）。在对混杂因素进行调整后，总体CTD（主要或未分化）（比值比=3.54，95%置信区间；1.61-7.78）和TPO-a加TG-a阳性（比值比=2.78，95%置信区间；1.29-5.98）与妊娠中重度并发症（流产、胎儿生长受限、先兆子痫、34周前分娩）风险增加独立相关。
妊娠期间风湿和甲状腺自身抗体密切相关。甲状腺抗体可能会增加与结缔组织病相关的不良妊娠结局风险。
