L-T4干预对妊娠早期合并亚临床甲状腺功能减退症孕妇发生早产风险的荟萃分析

Effects of levothyroxine intervention on premature delivery occurrence risk in early pregnant women complicating subclinical hypothyroidism:a meta analysis

目的探讨左旋甲状腺素(L-T4)干预对妊娠早期合并亚临床甲状腺功能减退症孕妇发生早产风险的影响。方法检索PubMed、EMBASE、Cochrane library、EBSCO、万方CBM等数据库,收集1980年1月至2017年3月期间发表的妊娠合并亚临床甲减的相关文献,按照纳入标准删除不符合要求的研究,采用RevMan5.3软件进行荟萃分析。结果 (1)妊娠合并亚临床甲减孕妇未干预发生早产风险的荟萃研究共纳入12篇文献(累积样本5 612例,累积发生早产368例),L-T4干预孕妇802例,对照组均为甲状腺正常的孕妇(4 810例),合并OR为3.46,95%CI为2.64~4.54,P<0.05。(2)经L-T4治疗的妊娠合并亚临床甲减发生早产风险的荟萃研究共纳入21篇文献(累积样本2 561例,累积发生早产286例),合并OR为5.37,95%CI为3.90~7.38,P<0.05)。结论妊娠早期合并亚临床甲减会增加早产发生的风险,而采用L-T4进行干预治疗可以明显降低早产的发生风险。

Objective To investigate the effect of levothyroxine（L-T4） intervention on premature delivery occurrence risk in early pregant women complicating subclinical hypothyroidism.Methods The databases of PubMed,EMBASE,EBSCO,Cochrane library,CBM and Wanfangdata were retrieved for collecting the related literatures on pregnancy complicating subclinical hypothyroidism published from January 1980 to March 2017.The undesirable studies were deleted according to the inclusion standard.The meta analysis was performed by using the RevMan5.3 software.Results （1） The 12 articles on premature delivery occurrence risk in pregnan women complicating subclinical hypothyroidism without intervention were included（accumulated 5 612 cases of samples and accumulated 368 cases of premature delivery）,802 pregnant women received L-T4 intervention,the control group （4 810 cases） was the pregnant women of normal thyroid.The merged OR was 3.46,95%CI 2.64-4.54,P〈0.05.（2） Twenty-one articles on premature delivery occurrence risk in pregnan women complicating subclinical hypothyroidism treated by L-T4 in meta analysis were included（accumulated 2561 cases of samples and accumulated 286 cases of premature delivery）.The merged ORwas 5.37,95%CI 3.90-7.38,P〈0.05）.Conclusion Early pregnancy complicating subclinical hypothyroidism can increase the risk of preterm birth,whereas adopting the L-T4 intervention therapy can significantly reduce the risk of premature delivery occurrence.