甲状腺自身免疫异常与体外受精-胚胎移植妊娠结局的相关性研究

Relationship between anti-thyroid antibody and pregnancy outcome of in vitro fertilization and embryo transfer

目的探讨甲状腺自身抗体（ATA）对体外受精-胚胎移植（IVF-ET）妊娠结局的影响。方法收集2011年8月～12月在贵阳医学院附属医院生殖中心接受IVF-ET治疗的153例不育妇女血清，采用化学发光法检测ATA，包括甲状腺球蛋白抗体（TG-Ab）和甲状腺过氧化物酶抗体（TPO—Ab），其中ATA阳性组患者39例，ATA阴性组114例；对患者的临床资料、促排卵参数及妊娠结局进行分析，并对其中110例患者卵泡液中ATA进行检测。结果ATA阳性组流产率显著高于ATA阴性组，有显著性差异（P〈0．05），但两组的受精率、种植率、妊娠率比较无统计学差异（P〉0．05）；所收集的110例患者卵泡液与血清中ATA水平呈正相关，其中TG-Ab r=0．93（P％0．05），TPO—Ab r=0．836（P％0．05）。结论ATA阳性患者行IVF—ET后妊娠流产率显著升高。不育妇女尤其是反复流产、反复IVF—ET失败患者，筛查ATA对指导诊疗、预测妊娠结局具有重要的临床价值。

Objective： To investigate the impact of anti-thyroid antibody（ATA）on pregnancy outcome of in vitro fertilization and embryo transfer（IVF-ET）. Methods： The data of 153 infertile patients patients during IVF-ET treatment from August of 153 infertile women were collected on the antibody （TG-Ab） and anti-thyroid peroxidase including 39 ATA positive patients and 114 ATA negative 2011 to December 2011 were ana day of ovum pick-up. ATA inc yzed. The serum samples uding anti-thyroglobulin antibody （TPO-Ab） were measured by chemiluminescence method. The clinical data, controlled ovarian hyperstimulation （COH）data and IVF outcome were recorded. Then the TG-Ab and TPG-Ab levels in follicular fluid were measured in 110 women. Results： The miscarriage rate in ATA positive group were significantly higher than those in ATA negative group（P〈0. 05）. There were no significant differences in the fertilization rate,implantation rate and pregnancy rate between the two groups. ATA levels in follicular fluid of 110 women were strongly correlated with those in serum[TG-Ab r=0.93（P〈0.05） ,TPO-Ab r=0. 836（P〈0.05）]; Conclusions： Miscarriage rate after IVF-ET pregnancy is significantly higher in positive ATA patients. Therefore,screening ATA has an important clinical value for guiding diagnosis, treatment and predicting pregnancy outcome, especially for recurrent spontaneous abortion or recurrent IVF-ET failure patients.