甲状腺自身抗体和促甲状腺素预测流产的价值

The value of thyroid autoantibody and thyroid stimulating hormone for predicting abortion

目的探讨甲状腺自身抗体和促甲状腺素(TSH)预测流产的价值。方法选择因孕前或孕早期咨询就诊的育龄妇女230例,常规筛查甲状腺自身抗体和TSH,并追访至妊娠3个月,其中42例流产(流产组),188例持续妊娠(持续妊娠组)。比较甲状腺自身抗体和TSH引起流产的情况。结果①甲状腺自身抗体阳性患者流产率为62.5%,TSH≥2.5mIU/L的亚临床甲减患者流产率为66.7%(6/9例),差异无统计学意义(P=0.000);②在流产组和持续妊娠组中,甲状腺自身抗体的阳性率分别为47.6%和6.4%,TSH≥2.5mIU/L的检出率分别为14.3%和1.6%,差异均有统计学意义(P<0.001,P=0.001);③TSH≥2.5mIU/L伴自身抗体阳性5例,均发生流产,单纯自身抗体阳性27例,流产率为55.6%,单纯TSH≥2.5mIU/L4例,流产率为25%,TSH<2.5mIU/L伴自身抗体阴性194例,流产率为10.8%,差异有统计学意义(P<0.001);④甲状腺自身抗体较TSH预测流产的价值更大,差异有统计学意义(P=0.003)。结论甲状腺自身抗体和TSH均是预测流产的重要指标,且甲状腺自身抗体的预测价值更大,两者联合可能具有更大的预测价值。

Objective To study the value of thyroid autoantibody and thyroid stimulating hormone（TSH）for predicting abortion.Methods Thyroid autoantibody and TSH were detected conventionally in 230 women before or in the early pregnancy.After 3 monthes＇ fellow-up,42 abortion occurred（abortion group）and the other 188 cases were pregnant healthy（pregnancy group）.Level of thyroid autoantibody and TSH were compared in the two groups.Results ① The abortion rates in patients with TSH≥2.5 mIU/L and positive thyroid autoantibody were 66.7% and 62.5%（P=0.000）.② The positive rates of thyroid autoantibody in abortion group was significant higher than that in pregnant group（47.6% vs 6.4%,P0.001）.Similarly,the positive rate of TSH in abortion group also higher than that in pregnant group（14.3% vs 1.6%,P=0.001）.③ 5 cases with TSH≥2.5mIU/L and positive thyroid autoantibody aborted with the abortion rate 100%.The abortion rates in women with single positive thyroid autoantibody,single TSH≥2.5 mIU/L,TSH2.5mIU/L and negative thyroid autoantibody were 100%,55.6%,25% and 10.8%,respectively.④ The predictive value of positive thyroid autoantibody was greater than TSH（P=0.003）.Conclusions Both thyroid autoantibody and TSH are useful index for predicting abortion.The predictive value of thyroid autoantibody was more valuable.Combination of thyroid autoantibody and TSH may increase the predictive value.