特发性卵巢储备功能减退与自身免疫性甲状腺疾病的关系

Association between idiopathic diminished ovarian reserve and thyroid autoimmunity

目的探索特发性卵巢储备功能减退与自身免疫性甲状腺疾病(TAI)的关系。方法排除已知原因(医源性、遗传性及除TAI以外的其他自身免疫性疾病)导致卵巢储备降低后,将348例于同一天检测抗苗勒管激素(AMH)、促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TGAb)并且符合条件的患者按照AMH水平分为特发性卵巢储备功能减退(DOR)组和正常卵巢储备(NOR)组,比较DOR组和NOR组甲状腺激素、甲状腺抗体水平以及甲状腺功能减退(甲减)、甲状腺抗体(TPOAb、TGAb)阳性率;将患者按照年龄分为低育龄(21~30岁)、中育龄(31~35岁)、高育龄(36~40岁)三个年龄段,比较各育龄段DOR组和NOR组间以上指标的差异。结果总体研究病例,DOR组和NOR组甲状腺激素水平、甲状腺抗体水平、甲减患病率、甲状腺抗体阳性率比较均无统计学差异(P均>0.05)。根据年龄分层分析后,在中育龄女性,DOR组相对于NOR组,TSH水平低而TPOAb阳性率高(P均<0.05)。二分类Logistic回归模型在调整年龄和TSH水平后,TPOAb阳性对卵巢功能的影响仍有统计学差异(OR=3.387,P<0.05)。结论在中育龄(31~35岁)女性中特发性卵巢储备功能减退与高TPOAb阳性率有关。

Objective To explore the association between idiopathic diminished ovarian reserve and thyroid autoimmunity(TAI).Methods After excluding the patients with known causes compromising diminished ovarian reserve(iatrogenic,genetic and other autoimmune diseases other than TAI),348 eligible patients with detections of anti-Müllerian hormone(AMH),thyroid-stimulating hormone(TSH),free triiodothyronine(FT3),free thyroxine(FT4),thyroid peroxidase antibody(TPOAB)and thyroglobulin antibody(TGAB)on the same day were enrolled.These patients were then divided into two groups according to AMH value:the diminished ovarian reserve(DOR)group and the normal ovarian reserve(NOR)group.The levels of thyroid hormones and antibodies,and the prevalence of hypothyroidism and thyroglobulin autoantibody(TPOAb and TGAb)were compared between the DOR group and NOR group.According to the age,the patients were divided into three different age groups of low childbearing age(21-30 years),middle childbearing age(31-35 years),and high childbearing age(36-40 years).The differences in the above indicators were compared between the two groups of different childbearing age groups.Results For the whole study population,no significant differences were found in the levels of thyroid hormones,antibodies or the prevalence of hypothyroidism and positive antithyroid antibody between the DOR group and NOR group(all P>0.05).After age stratification,in the middle childbearing age group,the level of TSH in the DOR group was lower than that in the NOR group,and the positive rate of TPOAb was higher(both P<0.05).The effect of TPOAb positivity on ovarian reserve had statistical difference after adjusting for age and TSH level in the binary Logistic regression model(OR=3.387,P<0.05).Conclusion In the middle childbearing age group(31-35 years old),idiopathic DOR is related to high TPOAb positive rate.