甲状腺自身免疫与甲状腺功能正常女性卵巢储备功能下降的关系。
Association between thyroid autoimmunity and the decline of ovarian reserve in euthyroid women.
机构信息
Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan Shandong 250012, China; Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan Shandong 250012, China; Shandong Key Laboratory of Reproductive Medicine, Jinan Shandong 250012, China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan Shandong 250012, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan Shandong 250012, China.
Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan Shandong 250012, China; Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan Shandong 250012, China; Shandong Key Laboratory of Reproductive Medicine, Jinan Shandong 250012, China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan Shandong 250012, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan Shandong 250012, China; Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen Guangdong 518045, China.
出版信息
Reprod Biomed Online. 2022 Sep;45(3):615-622. doi: 10.1016/j.rbmo.2022.05.015. Epub 2022 May 30.
RESEARCH QUESTION
Is thyroid autoimmunity (TAI) associated with the decline of ovarian reserve in euthyroid women?
DESIGN
Case-control study. Data from 4302 euthyroid women with normal ovarian reserve (NOR) and low ovarian reserve (LOR), including biochemical premature ovarian insufficiency (POI) and overt POI, were retrospectively analysed. The prevalence and effect of TAI on ovarian reserve was evaluated between women with NOR and LOR. Status of ovarian insufficiency and TSH levels was further stratified for analysis. The correlation between anti-thyroid peroxidase antibody (TPOAb), anti-thyroglobulin antibody (TgAb) titres and ovarian reserve markers was also determined.
RESULTS
The prevalence of positive TAI and TgAb was equally distributed between women with NOR and LOR (P = 0.080, P = 0.172); the prevalence of TPOAb positivity was higher in the LOR group (P = 0.005). After stratifying ovarian reserve and TSH, positive TAI, TPOAb and TGAb were significantly associated with overt POI when TSH was >2.5 µIU/ml (all P < 0.001); no association was observed with biochemical POI or overt POI when TSH was ≤2.5 µIU/ml. No correlation was found between TPOAb, TGAb titres and AMH (P = 0.218, P = 0.368, respectively), and bilateral AFC (P = 0.184, P = 0.315, respectively) in patients with LOR; only TPOAb titre was positively correlated with FSH (P = 0.039).
CONCLUSIONS
Among the whole population of euthyroid women, TAI was not associated with low ovarian reserve but was significantly associated with overt POI in women with TSH>2.5 µIU/ml. Further basic studies on underlying mechanisms are needed.
研究问题
甲状腺自身免疫（TAI）是否与甲状腺功能正常的女性卵巢储备功能下降有关？
设计
病例对照研究。回顾性分析了 4302 名甲状腺功能正常、卵巢储备正常（NOR）和卵巢储备低（LOR）的女性（包括生化性卵巢早衰和显性卵巢早衰）的数据。评估了 NOR 和 LOR 女性中 TAI 的发生率及其对卵巢储备的影响。进一步对卵巢功能不全的状态和 TSH 水平进行分层分析。还确定了抗甲状腺过氧化物酶抗体（TPOAb）、抗甲状腺球蛋白抗体（TgAb）滴度与卵巢储备标志物之间的相关性。
结果
NOR 和 LOR 女性中 TAI 和 TgAb 阳性的发生率相当（P=0.080，P=0.172）；而 LOR 组 TPOAb 阳性率较高（P=0.005）。在分层卵巢储备和 TSH 后，当 TSH >2.5 µIU/ml 时，TAI、TPOAb 和 TGAb 阳性与显性卵巢早衰显著相关（均 P<0.001）；当 TSH ≤2.5 µIU/ml 时，与生化性卵巢早衰或显性卵巢早衰均无相关性。在 LOR 患者中，TPOAb、TgAb 滴度与 AMH 之间无相关性（P=0.218，P=0.368），与双侧 AFC 之间无相关性（P=0.184，P=0.315）；仅 TPOAb 滴度与 FSH 呈正相关（P=0.039）。
结论
在整个甲状腺功能正常的女性人群中，TAI 与低卵巢储备无关，但与 TSH>2.5 µIU/ml 的女性显性卵巢早衰显著相关。需要进一步进行基础研究以探讨其潜在机制。
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