Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Taizhou Women and Children's Hospital Affiliated to Wenzhou Medical University, Taizhou, China.
Am J Reprod Immunol. 2020 Jun;83(6):e13238. doi: 10.1111/aji.13238. Epub 2020 Apr 11.
The effect of thyroid autoimmunity (TAI) on the prevalence of recurrent miscarriage (RM) is highly debatable. No meta-analysis has been published in the past decade to investigate the impact of TAI on women with RM.
Systemic literature search was conducted on PubMed, Embase, Cochrane, and Web of Science databases. English language literatures published between 1993 and 2019 were selected. We assessed the relationship between the prevalence of RM and thyroid peroxidase antibodies (TPO-Ab) or antithyroid antibodies (ATA) and evaluated the thyroid-stimulating hormone (TSH) level in TPO-Ab-positive women with RM. We also observed the treatment effect with levothyroxine (LT4) for RM. Review Manager 5.3 software was used to obtain the pooled odds ratios (OR).
Analysis of 22 eligible studies revealed significant association between TPO-Ab and the prevalence of RM (OR = 1.85; 95% CI, 1.38 to 2.49; P < .001)(n ≥ 3), (OR = 1.82; 95% CI, 1.13 to 2.92; P = .01) (n ≥ 3). Women with ATA + had higher risk of RM (OR = 2.36; 95% CI, 1.71 to 3.25; P < .00001)(n ≥ 3), (OR = 2.34; 95% CI, 1.70 to 3.22; P < .00001)(n ≥ 2). RM women with TPO-Ab had higher TSH level when compared with those negative for TPO-Ab (random-effect SMD = 0.60; 95% CI, 0.31 to 0.90; P < .0001). We also found beneficial effects of LT4 supplementation on the outcome of live birth rate (LBR) among pregnant women with TPO-Ab (OR = 3.04; 95% CI, 0.69 to 13.36; P = .14).
The presence of serum antithyroid antibodies does harms to women and can even lead to recurrent miscarriage; LT4 treatment may have beneficial to RM women.
甲状腺自身免疫（TAI）对复发性流产（RM）发生率的影响仍存在争议。在过去的十年中，没有发表过关于 TAI 对 RM 女性影响的荟萃分析。
对 PubMed、Embase、Cochrane 和 Web of Science 数据库进行系统性文献检索。选择 1993 年至 2019 年发表的英文文献。我们评估了 RM 与甲状腺过氧化物酶抗体（TPO-Ab）或抗甲状腺抗体（ATA）之间的患病率关系，并评估了 TPO-Ab 阳性 RM 妇女的促甲状腺激素（TSH）水平。我们还观察了左甲状腺素（LT4）治疗 RM 的效果。使用 Review Manager 5.3 软件获取合并优势比（OR）。
对 22 项符合条件的研究进行分析后发现，TPO-Ab 与 RM 的患病率之间存在显著相关性（OR=1.85；95%CI，1.38 至 2.49；P<.001）（n≥3），（OR=1.82；95%CI，1.13 至 2.92；P=0.01）（n≥3）。ATA+的女性发生 RM 的风险更高（OR=2.36；95%CI，1.71 至 3.25；P<.00001）（n≥3），（OR=2.34；95%CI，1.70 至 3.22；P<.00001）（n≥2）。与 TPO-Ab 阴性的 RM 妇女相比，TPO-Ab 阳性的 RM 妇女 TSH 水平更高（随机效应 SMD=0.60；95%CI，0.31 至 0.90；P<.0001）。我们还发现，在 TPO-Ab 阳性的孕妇中，LT4 补充对活产率（LBR）的结局有有益的影响（OR=3.04；95%CI，0.69 至 13.36；P=0.14）。
血清抗甲状腺抗体的存在对女性有害，甚至可能导致复发性流产；LT4 治疗可能对 RM 女性有益。
