甲状腺自身抗体和促甲状腺素预测流产的价值

目的探讨甲状腺自身抗体和促甲状腺素（TSH）预测流产的价值。方法选择因孕前或孕早期咨询就诊的育龄妇女230例,常规筛查甲状腺自身抗体和TSH,并追访至妊娠3个月,其中42例流产（流产组）,188例持续妊娠（持续妊娠组）。比较甲状腺自身抗体和TSH引起流产的情况。结果①甲状腺自身抗体阳性患者流产率为62.5%,TSH≥2.5mIU/L的亚临床甲减患者流产率为66.7%（6/9例）,差异无统计学意义（P=0.000）;②在流产组和持续妊娠组中,甲状腺自身抗体的阳性率分别为47.6%和6.4%,TSH≥2.5mIU/L的检出率分别为14.3%和1.6%,差异均有统计学意义（P〈0.001,P=0.001）;③TSH≥2.5mIU/L伴自身抗体阳性5例,均发生流产,单纯自身抗体阳性27例,流产率为55.6%,单纯TSH≥2.5mIU/L4例,流产率为25%,TSH〈2.5mIU/L伴自身抗体阴性194例,流产率为10.8%,差异有统计学意义（P〈0.001）;④甲状腺自身抗体较TSH预测流产的价值更大,差异有统计学意义（P=0.003）。结论甲状腺自身抗体和TSH均是预测流产的重要指标,且甲状腺自身抗体的预测价值更大,两者联合可能具有更大的预测价值。

The value of thyroid autoantibody and thyroid stimulating hormone for predicting abortion

Objective To study the value of thyroid autoantibody and thyroid stimulating hormone（TSH）for predicting abortion.Methods Thyroid autoantibody and TSH were detected conventionally in 230 women before or in the early pregnancy.After 3 monthes＇ fellow-up,42 abortion occurred（abortion group）and the other 188 cases were pregnant healthy（pregnancy group）.Level of thyroid autoantibody and TSH were compared in the two groups.Results ① The abortion rates in patients with TSH≥2.5 mIU/L and positive thyroid autoantibody were 66.7% and 62.5%（P=0.000）.② The positive rates of thyroid autoantibody in abortion group was significant higher than that in pregnant group（47.6% vs 6.4%,P0.001）.Similarly,the positive rate of TSH in abortion group also higher than that in pregnant group（14.3% vs 1.6%,P=0.001）.③ 5 cases with TSH≥2.5mIU/L and positive thyroid autoantibody aborted with the abortion rate 100%.The abortion rates in women with single positive thyroid autoantibody,single TSH≥2.5 mIU/L,TSH2.5mIU/L and negative thyroid autoantibody were 100%,55.6%,25% and 10.8%,respectively.④ The predictive value of positive thyroid autoantibody was greater than TSH（P=0.003）.Conclusions Both thyroid autoantibody and TSH are useful index for predicting abortion.The predictive value of thyroid autoantibody was more valuable.Combination of thyroid autoantibody and TSH may increase the predictive value.