中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2014年
11期
816-822
,共7页
王少为%李旻%褚德发%梁琳%赵晓东%张俊荣
王少為%李旻%褚德髮%樑琳%趙曉東%張俊榮
왕소위%리민%저덕발%량림%조효동%장준영
妊娠初期%甲状腺功能减退症%早产%甲状腺%自身抗体%危险因素%Meta分析
妊娠初期%甲狀腺功能減退癥%早產%甲狀腺%自身抗體%危險因素%Meta分析
임신초기%갑상선공능감퇴증%조산%갑상선%자신항체%위험인소%Meta분석
Pregnancy trimester,first%Hypothyroidism%Premature birth%Thyroid gland%Autoantibodies%Risk factors%Meta-analysis
目的 探讨妊娠早期合并临床或亚临床甲状腺功能减退症(甲减)和甲状腺自身抗体阳性与早产发生风险的关系.方法 计算机检索PubMed数据库、EMBASE数据库、万方医学数据库、中国生物医学文献数据库和中国学术期刊网络出版总库,收集1980年1月1日至2013年12月31日期间发表的相关文献,中文检索词为甲状腺功能减退、亚临床甲状腺功能减退、低甲状腺素血症、甲状腺自身抗体、早产、队列研究等.英文检索词为hypothyroidism、subclinical hypothyroidism、hypothyroxinnism、thyroid antibody、pretermlabor、preterm birth等.(1)纳入标准:研究设计为临床研究,研究病例数≥10例;暴露为临床或亚临床甲减、低甲状腺素血症、甲状腺自身抗体阳性,目标事件为早产.(2)排除标准:临床研究病例数少于10例的文献,对照组不是甲状腺功能正常的孕妇.采用RevMaa 5软件进行荟萃分析,妊娠合并临床或亚临床甲减的例数、甲状腺自身抗体阳性的例数、早产事件发生率等计数资料以OR值或RR值作为分析的统计量.结果 (1)共纳入20篇队列研究文献,总队列例数498 418例,累计发生早产39 596例;20篇文献的对照组均为甲状腺功能正常的孕妇.(2)妊娠合并临床甲减:有8个研究被纳入,共计478418例孕妇,妊娠合并临床甲减孕妇5 473例,对照组孕妇472 945例.荟萃分析结果显示,妊娠合并临床甲减孕妇早产的发生风险明显高于对照组(OR=1.25,95％ CI为1.15～1.36,P＜0.01).(3)妊娠合并亚临床甲减:有10个研究被纳入,共277 531例妊娠,妊娠合并亚临床甲减孕妇5 257例,对照组孕妇272 274例.荟萃分析结果显示,妊娠合并亚临床甲减孕妇发生早产的风险明显高于对照组(OR=1.25,95％ CI为1.14～1.36,P＜0.01).(4)妊娠合并甲状腺自身抗体阳性:有11个研究被纳入,共28 781例妊娠,妊娠合并甲状腺自身抗体阳性孕妇3 036例,对照组孕妇25 745例.荟萃分析结果显示,妊娠合并甲状腺自身抗体阳性孕妇发生早产的风险明显高于对照组(OR=1.47,95％ CI为1.27～1.70,P＜0.01).漏斗图的对称性较好,不存在发表偏倚.结论 妊娠早期合并临床或亚临床甲减和甲状腺自身抗体阳性是发生早产的危险因素.
目的 探討妊娠早期閤併臨床或亞臨床甲狀腺功能減退癥(甲減)和甲狀腺自身抗體暘性與早產髮生風險的關繫.方法 計算機檢索PubMed數據庫、EMBASE數據庫、萬方醫學數據庫、中國生物醫學文獻數據庫和中國學術期刊網絡齣版總庫,收集1980年1月1日至2013年12月31日期間髮錶的相關文獻,中文檢索詞為甲狀腺功能減退、亞臨床甲狀腺功能減退、低甲狀腺素血癥、甲狀腺自身抗體、早產、隊列研究等.英文檢索詞為hypothyroidism、subclinical hypothyroidism、hypothyroxinnism、thyroid antibody、pretermlabor、preterm birth等.(1)納入標準:研究設計為臨床研究,研究病例數≥10例;暴露為臨床或亞臨床甲減、低甲狀腺素血癥、甲狀腺自身抗體暘性,目標事件為早產.(2)排除標準:臨床研究病例數少于10例的文獻,對照組不是甲狀腺功能正常的孕婦.採用RevMaa 5軟件進行薈萃分析,妊娠閤併臨床或亞臨床甲減的例數、甲狀腺自身抗體暘性的例數、早產事件髮生率等計數資料以OR值或RR值作為分析的統計量.結果 (1)共納入20篇隊列研究文獻,總隊列例數498 418例,纍計髮生早產39 596例;20篇文獻的對照組均為甲狀腺功能正常的孕婦.(2)妊娠閤併臨床甲減:有8箇研究被納入,共計478418例孕婦,妊娠閤併臨床甲減孕婦5 473例,對照組孕婦472 945例.薈萃分析結果顯示,妊娠閤併臨床甲減孕婦早產的髮生風險明顯高于對照組(OR=1.25,95％ CI為1.15～1.36,P＜0.01).(3)妊娠閤併亞臨床甲減:有10箇研究被納入,共277 531例妊娠,妊娠閤併亞臨床甲減孕婦5 257例,對照組孕婦272 274例.薈萃分析結果顯示,妊娠閤併亞臨床甲減孕婦髮生早產的風險明顯高于對照組(OR=1.25,95％ CI為1.14～1.36,P＜0.01).(4)妊娠閤併甲狀腺自身抗體暘性:有11箇研究被納入,共28 781例妊娠,妊娠閤併甲狀腺自身抗體暘性孕婦3 036例,對照組孕婦25 745例.薈萃分析結果顯示,妊娠閤併甲狀腺自身抗體暘性孕婦髮生早產的風險明顯高于對照組(OR=1.47,95％ CI為1.27～1.70,P＜0.01).漏鬥圖的對稱性較好,不存在髮錶偏倚.結論 妊娠早期閤併臨床或亞臨床甲減和甲狀腺自身抗體暘性是髮生早產的危險因素.
목적 탐토임신조기합병림상혹아림상갑상선공능감퇴증(갑감)화갑상선자신항체양성여조산발생풍험적관계.방법 계산궤검색PubMed수거고、EMBASE수거고、만방의학수거고、중국생물의학문헌수거고화중국학술기간망락출판총고,수집1980년1월1일지2013년12월31일기간발표적상관문헌,중문검색사위갑상선공능감퇴、아림상갑상선공능감퇴、저갑상선소혈증、갑상선자신항체、조산、대렬연구등.영문검색사위hypothyroidism、subclinical hypothyroidism、hypothyroxinnism、thyroid antibody、pretermlabor、preterm birth등.(1)납입표준:연구설계위림상연구,연구병례수≥10례;폭로위림상혹아림상갑감、저갑상선소혈증、갑상선자신항체양성,목표사건위조산.(2)배제표준:림상연구병례수소우10례적문헌,대조조불시갑상선공능정상적잉부.채용RevMaa 5연건진행회췌분석,임신합병림상혹아림상갑감적례수、갑상선자신항체양성적례수、조산사건발생솔등계수자료이OR치혹RR치작위분석적통계량.결과 (1)공납입20편대렬연구문헌,총대렬례수498 418례,루계발생조산39 596례;20편문헌적대조조균위갑상선공능정상적잉부.(2)임신합병림상갑감:유8개연구피납입,공계478418례잉부,임신합병림상갑감잉부5 473례,대조조잉부472 945례.회췌분석결과현시,임신합병림상갑감잉부조산적발생풍험명현고우대조조(OR=1.25,95％ CI위1.15～1.36,P＜0.01).(3)임신합병아림상갑감:유10개연구피납입,공277 531례임신,임신합병아림상갑감잉부5 257례,대조조잉부272 274례.회췌분석결과현시,임신합병아림상갑감잉부발생조산적풍험명현고우대조조(OR=1.25,95％ CI위1.14～1.36,P＜0.01).(4)임신합병갑상선자신항체양성:유11개연구피납입,공28 781례임신,임신합병갑상선자신항체양성잉부3 036례,대조조잉부25 745례.회췌분석결과현시,임신합병갑상선자신항체양성잉부발생조산적풍험명현고우대조조(OR=1.47,95％ CI위1.27～1.70,P＜0.01).루두도적대칭성교호,불존재발표편의.결론 임신조기합병림상혹아림상갑감화갑상선자신항체양성시발생조산적위험인소.
Objective To evaluate the relationship between clinical or subclinical hypothyroidism and positive thyroid autoantibody before 20 weeks pregnancy and risk of preterm birth.Methods Literature search was done in PubMed,EMBASE,Wanfang Medical Database,China Academic Journal Network Publishing Database and China Biology Medicine disc databases from January 1st,1980 to December 31th,2013.The following search terms were used:hypothyroidism,subclinical hypothyroidism,hypothyroxinnism,thyroid antibody,preterm labor,preterm birth,etc.(1) Criteria for inclusion:cohort studies and clinical studies were included; only articles that described at least l0 patients were eligible;the exposure was clinical or subclinical hypothyroidism and positive thyroid autoantihody,and outcome was preterm birth.(2) The excluded subjects were articles that described less than 10 patients; controls were pregnant women without eurothyrodisim.Meta-analysis was performed by RevMan 5.The relationship between clinical or subclinical hypothyroidism and positive thyroid autoantibody and risk of preterm birth was evaluated by OR or RR.Results (1) Twenty cohort studies were enrolled.A total of 39 596 cases of preterm birth occurred among 498 418 pregnant women.The controls in these studies were pregnant women with eurothyrodisim.(2) Clinical hypothyroidism in pregnancy:eight studies were included,reported data on 478 418 pregnant women (5 473 women with clinical hypothyroidism and 472 945 euthyroid pregnant women).The risk of preterm birth in pregnant women with clinical hypothyroidism was higher than those eurothyroid pregnant women in control group (OR=1.25,95％ CI:1.15-1.36,P＜0.01).(3) Subclinical hypothyroidism in pregnancy:ten studies were included,reported data on 277 531 pregnant women (5 257 women with subclinical hypothyroidism and 272 274 euthyroid pregnant women).The risk of preterm birth in pregnant women with subclinical hypothyroidism was higher than those in control group by random effects analysis (OR=1.25,95％ CI:1.14-1.36,P＜0.01).(4) Thyroid autoantibodys positive in pregnancy:eleven studies were included,reported data on 28 781 pregnant women (3 036 women with thyroid autoanti body positive and 25 745 euthyroid pregnant women).The risk of preterm birth in pregnant women with positive thyroid autoantibody was higher than those negative thyroid autoantibody in control group (OR=1.47,95％ CI:1.27-1.70,P＜0.01).The funnel plots presented symmetrical graphics,indicating that there was no publication bias.Conclusion Clinical or subclinical hypothyroidism and positive thyroid autoantibody in pregnant women is risk factors of preterm birth.
