不同备孕 TSH 水平的女性接受 ART 结局的荟萃分析。
Meta-analysis of ART outcomes in women with different preconception TSH levels.
机构信息
Department of Endocrinology and Metabolism, Institute of Endocrinology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China.
The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
出版信息
Reprod Biol Endocrinol. 2018 Nov 5;16(1):111. doi: 10.1186/s12958-018-0424-0.
BACKGROUND
To assess whether elevated thyroid-stimulating hormone (TSH) levels before conception can predict poor outcomes of assisted reproductive technology (ART).
METHODS
Prior to July 2018, we searched the PubMed, EMBASE, COCHRANE, Google Scholar, and CNKI databases for studies. Retrospective or prospective reports that compared ART results in patients with subclinical hypothyroidism (SCH) with normal thyroid function were selected. Two reviewers separately reviewed each potential article for qualification, analyzed the quality of the studies according to the Newcastle-Ottawa scale, and extracted the data. The PRISMA guidelines were adopted.
RESULTS
We selected a total of 18 publications that included 14,846 participants for this meta-analysis. When the TSH cut-off value for SCH was set at 2.5 mIU/L, no significant differences were observed in ART-related outcomes between SCH patients and normal women. The evaluated outcomes included the live birth rate (LBR) (OR: 0.93; 95% CI (0.77,1.12), P = 0.43), clinical pregnancy rate (CPR) (OR:1.02; 95% CI (0.90,1.17); P = 0.74), pregnancy rate (PR) (OR: 1.00; 95% CI (0.89,1.12); P = 0.99), and miscarriage rate (MR) (OR:1.24; 95% CI (0.85, 1.80); P = 0.26). Furthermore, when a higher TSH level was used as the cut-off value to diagnose SCH (i.e., 3.5-5 mIU/L), a significant difference was found in the MR (OR: 1.91; 95% CI (1.09, 3.35); P = 0.02) between the two groups of ART-treated women. However, when a broader cut-off value was used to define SCH, no significant differences were observed in the LBR (OR: 0.72; 95% CI (0.47,1.11); P = 0.14), CPR (OR: 0.82; 95% CI (0.66,1.00); P = 0.052), or PR (OR: 1.07; 95% CI (0.72,1.60); P = 0.74) between the two groups of ART-treated women.
CONCLUSION
No difference was observed in ART outcomes when a TSH cut-off value of 2.5 mIU/L was used. However, when a broader TSH cut-off value was used, preconception SCH resulted in a higher miscarriage rate than in normal women.
背景
评估受孕前甲状腺刺激激素（TSH）水平升高是否可以预测辅助生殖技术（ART）的不良结局。
方法
在 2018 年 7 月之前，我们检索了 PubMed、EMBASE、COCHRANE、Google Scholar 和中国知网（CNKI）数据库中的研究。选择了比较亚临床甲状腺功能减退症（SCH）患者与甲状腺功能正常患者的 ART 结果的回顾性或前瞻性报告。两位审查员分别对每篇潜在文章进行资格审查，根据纽卡斯尔-渥太华量表评估研究质量，并提取数据。采用 PRISMA 指南。
结果
我们共选择了 18 篇文献，其中包括 14846 名参与者进行了这项荟萃分析。当 SCH 的 TSH 截断值设定为 2.5 mIU/L 时，SCH 患者与正常女性的 ART 相关结局无显著差异。评估的结局包括活产率（LBR）（OR：0.93；95%CI（0.77，1.12），P=0.43）、临床妊娠率（CPR）（OR：1.02；95%CI（0.90，1.17）；P=0.74）、妊娠率（PR）（OR：1.00；95%CI（0.89，1.12）；P=0.99）和流产率（MR）（OR：1.24；95%CI（0.85，1.80）；P=0.26）。此外，当使用更高的 TSH 水平作为截断值来诊断 SCH（即 3.5-5 mIU/L）时，两组接受 ART 治疗的女性之间的 MR（OR：1.91；95%CI（1.09，3.35）；P=0.02）存在显著差异。然而，当使用更广泛的截断值来定义 SCH 时，两组接受 ART 治疗的女性之间的 LBR（OR：0.72；95%CI（0.47，1.11）；P=0.14）、CPR（OR：0.82；95%CI（0.66，1.00）；P=0.052）或 PR（OR：1.07；95%CI（0.72，1.60）；P=0.74）无显著差异。
结论
当使用 2.5 mIU/L 的 TSH 截断值时，ART 结局无差异。然而，当使用更广泛的 TSH 截断值时，受孕前 SCH 导致流产率高于正常女性。
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