孕早期血清甲状腺激素自身抗体作为产后甲状腺炎预测指标的评估
Assessment of serum thyroid hormone autoantibodies in the first trimester of gestation as predictors of postpartum thyroiditis.
作者信息
Benvenga Salvatore, Vita Roberto, Di Bari Flavia, Lo Re Carmela, Scilipoti Angela, Giorgianni Grazia, Grasso Loredana, Galletti Marina Raffaella, Mandolfino Mattia Grazia, Le Donne Maria
机构信息
Department of Clinical and Experimental Medicine, University of Messina, Italy.
Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Italy.
出版信息
J Clin Transl Endocrinol. 2019 Jul 24;18:100201. doi: 10.1016/j.jcte.2019.100201. eCollection 2019 Dec.
BACKGROUND
Measurement of serum thyroperoxidase autoantibodies (TPOAb) during gestation as a classical marker for the risk of postpartum thyroiditis (PPT) predicts PPT in 1/3 to 1/2 of women. Very few studies have measured serum thyroid hormone Ab (THAb) during gestation, and none as a possible marker for PPT.
METHODS
In 412 women who were followed up from 7 to 11 weeks of gestation through 12 months after delivery, we measured THAb (T3.IgM, T3.IgG, T4.IgM, T4.IgG), thyroglobulin autoantibodies (TgAb) and TPOAb at study entry (7-11 week of gestation).
RESULTS
Sixty-three women (15.3%) developed PPT, which progressed to permanent hypothyroidism (PH) in 34/63 (54%). THAb+ve were 21/412 women (5.1%), the frequency being greater in those who then developed PPT (12/63 [19.0%] vs 9/349 [2.6%], P = 4.6 × 10), and in the PH subgroup (26.5% [9/34] vs 10.3% [10/29], P = 0.12). THAb positivity occurred in 9/76 women (11.8%) who were TgAb and/or TPOAb+ve compared to 12/336 women who were TgAb and TPOAb negative (3.6%, P = 0.0031). Of these 9 THAb+ve, TgAb and/or TPOAb+ve women, all (100%) developed PPT compared to 3/11 (27.3%, P = 0.0011) THAb+ve, TgAb and/or TPOAb negative women. Of these 9 and 3 PPT women, 8 and 1 progressed to PH (88.9% and 33.3%, respectively, P = 0.12).
CONCLUSIONS
Gestational positivity of THAb enhance enormously the predictivity for PPT of gestational positivity of TPOAb/TgAb. However, their low frequency (5.1%) and their sensitivity (17.5% [21/63]) go against their application in lieu of TPOAb/TgAb.
背景
孕期测量血清甲状腺过氧化物酶自身抗体（TPOAb）作为产后甲状腺炎（PPT）风险的经典标志物，可预测三分之一至二分之一的女性患PPT。很少有研究在孕期测量血清甲状腺激素抗体（THAb），且没有研究将其作为PPT的可能标志物。
方法
在412名从妊娠7至11周随访至产后12个月的女性中，我们在研究开始时（妊娠7 - 11周）测量了THAb（T3.IgM、T3.IgG、T4.IgM、T4.IgG）、甲状腺球蛋白自身抗体（TgAb）和TPOAb。
结果
63名女性（15.3%）发生了PPT，其中34/6（54%）进展为永久性甲状腺功能减退（PH）。THAb阳性的女性有21/412名（5.1%），在随后发生PPT的女性中频率更高（12/63 [19.0%] 对比9/349 [2.6%]，P = 4.6 × 10），在PH亚组中也是如此（26.5% [9/34] 对比10.3% [10/29]，P = 0.12）。在76名TgAb和/或TPOAb阳性的女性中有9名（11.8%）THAb阳性，而在336名TgAb和TPOAb阴性的女性中有12名（3.6%）THAb阳性（P = 0.0031）。在这9名THAb阳性、TgAb和/或TPOAb阳性的女性中，全部（100%）发生了PPT，相比之下，11名THAb阳性、TgAb和/或TPOAb阴性的女性中有3名（27.3%）发生了PPT（P = 0.0011）。在这9名和3名发生PPT的女性中，分别有8名和1名进展为PH（分别为88.9%和33.3%，P = 0.12）。
结论
THAb的孕期阳性极大地提高了TPOAb/TgAb孕期阳性对PPT的预测性。然而，其低频率（5.1%）和低敏感性（17.5% [21/63]）不利于其替代TPOAb/TgAb应用。
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