自身免疫性甲状腺炎对IVF临床结局的影响

发布时间：2018-05-17 11:12

本文选题：自身免疫性甲状腺炎 + 甲状腺球蛋白抗体　；参考：《浙江大学》2016年博士论文

【摘要】：研究背景：自身免疫性甲状腺炎是育龄期女性中最常见的自身免疫性疾病之一,也是造成育龄期女性甲状腺功能减退的第一大病因,其特点是存在甲状腺抗体(Anti-thyroid antibodies,ATA)。自身免疫性甲状腺炎在不孕女性中的患病率高于普通人群,与复发性流产、反复移植失败相关。研究目的：本研究的目的是探讨甲状腺功能正常的自身免疫性甲状腺炎(甲状腺抗体阳性)对IVF-ET临床结局的影响,以及左旋甲状腺素治疗的作用,为合并自身免疫性甲状腺炎的不孕患者制定更好的助孕策略提供依据。研究方法：回顾性地分析2013年8月1日至2015年4月1日间连续在浙江大学医学院附属妇产科医院生殖中心接受促排卵治疗和IVF-ET的管性不孕患者。共纳入481名患者,其中ATA阳性患者分为两组： (1)221名ATA阳性而未接受过左旋甲状腺素治疗的患者； (2)31名ATA阳性且正在接受左旋甲状腺素治疗的患者。另选取与实验组相同时间段内连续就诊的、夫妻双方年龄和BMI均与实验组匹配的的229名ATA阴性的管性不孕患者作为对照组。比较各组间获卵数、受精数、优质胚胎数、生化妊娠率、临床妊娠率、流产率、异位妊娠率、活产率、早产率、子代出生体重等信息。研究结果：ATA阳性治疗组TSH值(1.1±0.7IU/mL)显著低于ATA阳性未治疗组(1.6±0.5IU/mL)和对照组(1.5±0.5IU/mL)。ATA阳性治疗组、ATA阳性未治疗组和对照组的受精率分别为53.0%、56.0%和60.1%,ATA阳性的两组受精率均显著低于对照组(P0.05)。ATA阳性未治疗组和ATA阳性治疗组的着床率分别为31.8%和30.0%,均显著低于对照组58.2%(P0.05),基础FSH与受精率相关(r=0.090, P=0.049)。ATA阳性治疗组的生化妊娠率显著高于ATA阳性未治疗组和对照组。ATA阳性未治疗组的流产率显著高于对照组(8.4%VS 2.5%,P0.05)。在足月分娩的孕妇中,ATA阳性未治疗组的孕妇子代出生体重显著低于对照组(P0.05)。各组间获卵数、优质胚胎率、临床妊娠率、活产率、早产率、官外孕率、累计临床妊娠率、累计活产率均无显著差异。结论：(1)甲状腺抗体的存在显著降低患者行IVF-ET的受精率,基础FSH可能与受精率相关；(2)甲状腺抗体的存在显著增加生化妊娠率和流产率,降低着床率；(3)甲状腺抗体不影响获卵数、优质胚胎率、妊娠率、早产率和活产率；(4)甲状腺抗体的存在增加子代低出生体重的风险。
[Abstract]:Background: autoimmune thyroiditis is one of the most common autoimmune diseases in women of childbearing age. It is also the leading cause of hypothyroidism in women of childbearing age. The prevalence of autoimmune thyroiditis in infertile women was higher than that in the general population, which was related to recurrent abortion and repeated transplant failure. Objective: to investigate the effect of thyroid autoimmune thyroiditis (thyroid antibody positive) on the clinical outcome of IVF-ET and the effect of levothyroxine therapy. To provide evidence for the development of a better strategy for pregnancy aid in infertile patients with autoimmune thyroiditis. Methods: from August 1, 2013 to April 1, 2015, the patients who received ovulation promotion therapy and IVF-ET in the Reproductive Center of Department of Obstetrics and Gynecology Hospital affiliated to Zhejiang University Medical College were analyzed retrospectively. A total of 481 patients were enrolled. The patients with ATA positive were divided into two groups: 221 ATA positive patients and 31 ATA positive patients who were not treated with levothyroxine, and 31 patients who were receiving levothyroxine therapy. In addition, 229 patients with ATA negative tubal infertility were selected as control group, whose age and BMI matched with that of the experimental group in the same time period. The number of eggs, fertilization, high quality embryos, biochemical pregnancy rate, clinical pregnancy rate, abortion rate, ectopic pregnancy rate, live birth rate, preterm birth rate and birth weight of the offspring were compared. The results showed that the fertilization rates in the TSH positive treatment group (1.1 卤0.7) were significantly lower than those in the ATA positive untreated group (1.6 卤0.5) and in the control group (1.5 卤0.5IU/mL).ATA). The fertilization rates in the untreated group and the control group were 53.0% and 60.1%, respectively, which were significantly lower than those in the control group. The implantation rates of untreated group and ATA positive group were 31.8% and 30.0%, respectively, which were significantly lower than that of the control group (58.2%). The relationship between basal FSH and fertilization rate was 0.090. The biochemical pregnancy rate of P=0.049).ATA positive treatment group was significantly higher than that of ATA positive untreated group and control group. The abortion rate in the untreated group was significantly higher than that in the control group (8.4 vs 2.5). The birth weight of untreated pregnant women in full term delivery group was significantly lower than that of control group (P 0.05). There was no significant difference in the number of eggs, the rate of high quality embryos, the clinical pregnancy rate, the live delivery rate, the preterm delivery rate, the extraofficial pregnancy rate, the cumulative clinical pregnancy rate and the cumulative live birth rate among the groups. Conclusion (1) the presence of thyroid antibodies can significantly reduce the fertilization rate of IVF-ET in patients, and the existence of thyroid antibodies may be related to fertilization rate. The presence of thyroid antibodies can significantly increase the rate of biochemical pregnancy and abortion, and decrease the rate of implantation. 3) thyroid antibodies have no effect on the number of eggs obtained. The presence of thyroid antibodies increases the risk of low birth weight in offspring.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R581.4;R714.8

【相似文献】