甲状腺自身免疫与甲状腺功能正常不孕患者卵巢储备功能的关系研究

Study on the relationship between thyroid autoimmunity and ovarian reserve function in euthyroid infertile women

目的探究甲状腺自身免疫(TAI)与甲状腺功能正常不孕患者卵巢储备功能的关系。方法回顾性分析2021年1月至2023年10月在郑州大学第三附属医院生殖医学中心首次行IVF/ICSI-ET助孕的甲状腺功能正常的4567例不孕患者的临床资料。本中心甲状腺自身抗体(ATA)的参考值为:甲状腺髓过氧化物酶抗体(TPOAb)≤34 IU/ml,甲状腺球蛋白抗体(TgAb)≤115 IU/ml。TPOAb和/或TgAb为阳性的患者为ATA阳性组(571例),TPOAb和TgAb均为阴性的患者为ATA阴性组(3996例)。比较两组的卵巢储备功能指标,并进一步以年龄35岁和促甲状腺素(TSH)2.5 mIU/L为截点进行分层比较。结果ATA阳性组的年龄显著高于ATA阴性组(P<0.05),ATA阳性组的游离三碘甲状腺原氨酸(FT3)水平显著低于ATA阴性组(P<0.05)。校正年龄等混杂因素后,ATA阳性组的窦卵泡计数(AFC)显著低于ATA阴性组(P<0.05)。在TSH>2.5 mIU/L亚组中,ATA阳性组的AFC显著低于ATA阴性组(P<0.05);在年龄>35岁亚组中,ATA阳性组的抗苗勒管激素(AMH)水平和AFC均显著低于ATA阴性组(P<0.05)。结论TAI可能与甲状腺功能正常不孕女性的卵巢储备减退相关,且这种关联可能主要存在于高龄和TSH轻度升高的甲状腺功能正常不孕患者中。

Objective:To explore the relationship between thyroid autoimmunity(TAI)and ovarian reserve function in euthyroid infertile women.Methods:A retrospective analysis was conducted on the clinical data of 4567 euthyroid infertile patients who underwent their first IVF/ICSI cycle in the Center of Reproductive Medicine of the Third Affiliated Hospital of Zhengzhou University from January 2021 to October 2023.The reference values for antithyroid antibodies(ATA)in our center are as follows:thyroid peroxidase antibody(TPOAb)level≤34 IU/ml;thyroglobulin antibody level(TgAb)≤115 IU/ml.Patients who tested positive for TPOAb and/or TgAb were classified as ATA-positive group,while patients who tested negative for both TPOAb and TgAb were classified as ATA-negative group.Ovarian reserve function indicators were compared between the two groups and further stratified analysis were conducted using cut-off points including the age at 35 years old and thyroid stimulating hormone(TSH)at 2.5 mIU/L.Results:The age of patients was significantly higher in ATA-positive group than that of ATA-negative group(P<0.05).The free triiodothyronine(FT3)level in ATA-positive group was significantly lower than that in ATA-negative group(P<0.05).After adjusting for confounding factors such as age,the antral follicle count(AFC)showed significantly lower in the ATA-positive group when compared with the ATA-negative group(P<0.05).In the subgroup with TSH>2.5 mIU/L,the AFC was also significantly lower in ATA-positive group than that of ATA-negative group(P<0.05).In the subgroup of patients aged 35-40 years,both the anti-Müllerian hormone(AMH)level and AFC were significantly lower in ATA-positive group than those in ATA-negative group(P<0.05).Conclusions:TAI may be associated with diminished ovarian reserve in euthyroid infertile women,and this association may primarily exist in euthyroid infertile patients at advanced age and those with slightly elevated TSH levels.