Reproductive Medical Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Medicine (Baltimore). 2021 Apr 23;100(16):e25554. doi: 10.1097/MD.0000000000025554.
Thyroid autoimmune disease (TAI) has been verified to be related to multiple adverse pregnancy outcomes. A growing number of evidences highlight the protective roles of glucocorticoid on the treatments of TAI. This meta-analysis aimed to study whether it is beneficial to add glucocorticoid treatment in infertile women with TAI when they are undergoing assisted reproductive technology (ART).
We conducted a systematic search in PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), WanFang database, Weipu China Science and Technology Journal Databases (VIP database) up to September 10, 2020. The Revman 5.3 software was utilized for data statistics. We used a random-effects model to analyze data and the odds ratio (OR) combining with 95% confidence interval (95% CI) were employed to reveal the results.
Three publications with 237 antithyroid antibody (ATA)-positive and 384 ATA-negative women were included in the final analysis. Overall, glucocorticoid therapy showed satisfying effects on improving clinical pregnancy rate (OR = 4.63, 95% CI [2.23, 9.58], I2 = 0.0%, P < .0001) and live birth rate (OR = 3.19, 95% CI [1.13, 9.04], I2 = 0.0%, P = .03) of ATA-positive women compared with control group. However, it seems that glucocorticoid showed no significant difference in the abortion rate (OR = 0.62, 95% CI [0.09, 4.32], I2 = 35%, P = .64) and oocyte recovery (OR = 2.26, 95% CI [-1.46, 5.99], I2 = 79%, P < .0001) between the 2 groups.
Glucocorticoid may improve the pregnancy outcomes of ART women with ATA positive, but there is no significant reduction in the risk of miscarriage. Due to the limited enrolled references, glucocorticoid adjuvant therapy should be applied after more randomized controlled trials.
甲状腺自身免疫性疾病（TAI）已被证实与多种不良妊娠结局有关。越来越多的证据强调了糖皮质激素在治疗 TAI 中的保护作用。本荟萃分析旨在研究在接受辅助生殖技术（ART）的 TAI 不孕妇女中，加用糖皮质激素治疗是否有益。
我们系统地检索了 PubMed、EMBASE、Cochrane 图书馆、中国知网（CNKI）、万方数据库、维普中国科技期刊数据库（VIP 数据库），检索截至 2020 年 9 月 10 日。使用 RevMan 5.3 软件进行数据统计。我们采用随机效应模型进行数据分析，并用优势比（OR）结合 95%置信区间（95%CI）来揭示结果。
最终纳入了 3 项研究，共 237 例抗甲状腺抗体（ATA）阳性和 384 例 ATA 阴性的妇女。总体而言，糖皮质激素治疗在提高临床妊娠率（OR=4.63，95%CI[2.23，9.58]，I2=0.0%，P<.0001）和活产率（OR=3.19，95%CI[1.13，9.04]，I2=0.0%，P=.03）方面均显示出满意的效果，与对照组相比。然而，糖皮质激素似乎在流产率（OR=0.62，95%CI[0.09，4.32]，I2=35%，P=.64）和卵母细胞回收（OR=2.26，95%CI[-1.46，5.99]，I2=79%，P<.0001）方面两组间无显著差异。
糖皮质激素可能改善 ATA 阳性的 ART 妇女的妊娠结局，但不能显著降低流产风险。由于纳入的参考文献有限，糖皮质激素辅助治疗应在更多的随机对照试验后应用。
