本文選題：自身免疫性甲狀腺炎 + 甲狀腺球蛋白抗體��； 參考：《浙江大學(xué)》2016年博士論文

【摘要】：研究背景：自身免疫性甲狀腺炎是育齡期女性中最常見(jiàn)的自身免疫性疾病之一,也是造成育齡期女性甲狀腺功能減退的第一大病因,其特點(diǎn)是存在甲狀腺抗體(Anti-thyroid antibodies,ATA)。自身免疫性甲狀腺炎在不孕女性中的患病率高于普通人群,與復(fù)發(fā)性流產(chǎn)、反復(fù)移植失敗相關(guān)。研究目的：本研究的目的是探討甲狀腺功能正常的自身免疫性甲狀腺炎(甲狀腺抗體陽(yáng)性)對(duì)IVF-ET臨床結(jié)局的影響,以及左旋甲狀腺素治療的作用,為合并自身免疫性甲狀腺炎的不孕患者制定更好的助孕策略提供依據(jù)。研究方法：回顧性地分析2013年8月1日至2015年4月1日間連續(xù)在浙江大學(xué)醫(yī)學(xué)院附屬婦產(chǎn)科醫(yī)院生殖中心接受促排卵治療和IVF-ET的管性不孕患者。共納入481名患者,其中ATA陽(yáng)性患者分為兩組： (1)221名ATA陽(yáng)性而未接受過(guò)左旋甲狀腺素治療的患者； (2)31名ATA陽(yáng)性且正在接受左旋甲狀腺素治療的患者。另選取與實(shí)驗(yàn)組相同時(shí)間段內(nèi)連續(xù)就診的、夫妻雙方年齡和BMI均與實(shí)驗(yàn)組匹配的的229名ATA陰性的管性不孕患者作為對(duì)照組。比較各組間獲卵數(shù)、受精數(shù)、優(yōu)質(zhì)胚胎數(shù)、生化妊娠率、臨床妊娠率、流產(chǎn)率、異位妊娠率、活產(chǎn)率、早產(chǎn)率、子代出生體重等信息。研究結(jié)果：ATA陽(yáng)性治療組TSH值(1.1±0.7IU/mL)顯著低于ATA陽(yáng)性未治療組(1.6±0.5IU/mL)和對(duì)照組(1.5±0.5IU/mL)。ATA陽(yáng)性治療組、ATA陽(yáng)性未治療組和對(duì)照組的受精率分別為53.0%、56.0%和60.1%,ATA陽(yáng)性的兩組受精率均顯著低于對(duì)照組(P0.05)。ATA陽(yáng)性未治療組和ATA陽(yáng)性治療組的著床率分別為31.8%和30.0%,均顯著低于對(duì)照組58.2%(P0.05),基礎(chǔ)FSH與受精率相關(guān)(r=0.090, P=0.049)。ATA陽(yáng)性治療組的生化妊娠率顯著高于ATA陽(yáng)性未治療組和對(duì)照組。ATA陽(yáng)性未治療組的流產(chǎn)率顯著高于對(duì)照組(8.4%VS 2.5%,P0.05)。在足月分娩的孕婦中,ATA陽(yáng)性未治療組的孕婦子代出生體重顯著低于對(duì)照組(P0.05)。各組間獲卵數(shù)、優(yōu)質(zhì)胚胎率、臨床妊娠率、活產(chǎn)率、早產(chǎn)率、官外孕率、累計(jì)臨床妊娠率、累計(jì)活產(chǎn)率均無(wú)顯著差異。結(jié)論：(1)甲狀腺抗體的存在顯著降低患者行IVF-ET的受精率,基礎(chǔ)FSH可能與受精率相關(guān)；(2)甲狀腺抗體的存在顯著增加生化妊娠率和流產(chǎn)率,降低著床率；(3)甲狀腺抗體不影響獲卵數(shù)、優(yōu)質(zhì)胚胎率、妊娠率、早產(chǎn)率和活產(chǎn)率；(4)甲狀腺抗體的存在增加子代低出生體重的風(fēng)險(xiǎn)。
[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 鹵0.7) were significantly lower than those in the ATA positive untreated group (1.6 鹵0.5) and in the control group (1.5 鹵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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R581.4;R714.8

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