抗甲状腺抗体与复发性流产的关系及泼尼松治疗效果的观察

Association between antithyroid antibodies with recurrent spontaneous abortion and efficacy of prednison in patient treatment

目的研究抗甲状腺抗体(ATA)与复发性流产(RSA)之间的关系,初步探讨泼尼松对于ATA相关RSA的临床疗效。方法分别检测有RSA史非妊娠妇女120例(研究组),有正常妊娠史非妊娠健康妇女115例(对照组)及有ATA相关RSA史妊娠患者38例(治疗组)和未用激素治疗30例(未治疗组)的ATA水平[包括抗甲状腺过氧化物酶抗体(TPO-Ab)、抗甲状腺球蛋白抗体(TG-Ab)];治疗组妊娠前后给予中小剂量泼尼松治疗,并比较治疗前后的ATA水平,随访两组妊娠结局,比较两组间的活产率。结果研究组血清中ATA阳性率、TPO-Ab阳性率明显高于对照组(均P<0.05),TG-Ab阳性率虽高于对照组,但差异无统计学意义(P>0.05);治疗组治疗后ATA水平明显低于治疗前(P<0.05);治疗组活产率为65.79%,未治疗组为33.33%,差异有统计学意义(P<0.05)。结论ATA与RSA有关,尤其与TPO-Ab关系密切;中小剂量泼尼松能有效降低ATA水平,提高ATA相关的RSA患者的妊娠成功率,值得临床推广应用。

Objective To investigate the association between serum antithyroid antibodies （AIA） levels and recurrent spontaneous abortion （RSA） and the clinical efficacy of prednison in patients treatment. Methods One hundred twenty non-pregnant women with the history of RSA （study group） visiting obstetric and gynecologic clinic of our hospital from July 2013 to June 2014 and 115 healthy non-pregnant women （control group） were enrolled in the study. In addition, 38 patients with ATA-induced RSA treated with prednison before and after pregnancy in our hospital from July 2013 to June 2015 （treatment group） and 30 cases who were not treated （non-treated group） were also included. The serum levels of anti-thyroid peroxidase autoantibody （TPO-Ab）, anti-thyroglobulin antibody （TG-Ab） were tested and compared before and after treatment. The pregnancy outcomes were followed-up and compared between two groups. Results Serum ATA and TPO-Ab positive rates in the study group was 28.33% and 25.83%,which were significantly higher than those in the control group（15.85% and 13.91%, P〈 0.05）. In the treatment group, serum levels of TPO-Ab and TG-Ab after treatment were lower than those before treatment（P〈0.05）. The live birth rate in treatment group was 65.79%, significantly higher than that of non-treated group （33.33%, P〈0.05）. Conclusion Serum ATA and TPOAb levels are related to recurrent spontaneous abortion in pregnant women. Low dose of prednison can reduce serum level of ATA and increase live birth rate of patients with ATA-induced RSA.