NEJM:甲状腺过氧化物酶抗体阳性女性在孕前服用左旋甲状腺素的效果如何?

2019-04-04 xing.T 网络

由此可见,在甲状腺过氧化物酶抗体阳性的甲状腺功能正常女性中使用左旋甲状腺素不会得到比安慰剂更高的活产率。

即使甲状腺功能正常,甲状腺过氧化物酶抗体也会增加流产和早产的风险。小型试验表明使用左旋甲状腺素可以降低这种不良结局的发生率。

近日,顶级医学期刊NEJM上发表了一篇研究文章,研究人员进行了一项双盲、安慰剂对照试验,以研究左旋甲状腺素治疗是否会增加甲状腺过氧化物酶抗体阳性的甲状腺功能正常且有流产或不孕史的女性活产率。来自英国49家医院的19585名女性接受了甲状腺过氧化物酶抗体和甲状腺功能检测。研究人员随机分配了952名女性,在前受孕前至妊娠结束每天服用50μg左旋甲状腺素(476名女性)或安慰剂(476位女性)。该研究的主要结局是妊娠至少34周后的活产。

主要结局的随访率为98.7%(952名女性中有940名)。左甲状腺素组中470名女性中有266人(56.6%)怀孕,安慰剂组中470名女性中有274人(58.3%)怀孕。左旋甲状腺素组的活产率为37.4%(470名女性中有176名),安慰剂组为37.9%(470名女性中有178名)(相对风险为0.97; 95%置信区间[CI]为0.83至1.14,P=0.74;绝对差值为-0.4个百分点; 95%CI为-6.6至5.8)。其他妊娠结局(包括妊娠丢失或早产)或新生儿结局之间没有显著的组间差异。左甲状腺素组中5.9%的女性发生严重不良事件,安慰剂组为3.8%(P=0.14)。

由此可见,在甲状腺过氧化物酶抗体阳性的甲状腺功能正常女性中使用左旋甲状腺素不会得到比安慰剂更高的活产率。

原始出处:

Rima K. Dhillon-Smith, et al.Levothyroxine in Women with Thyroid Peroxidase Antibodies before Conception.NEJM.2019.https://www.nejm.org/doi/full/10.1056/NEJMoa1812537

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    2019-10-17 张文英

    学习了

    0

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    2019-04-06 smartxiuxiu

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1659594, encodeId=134316595947d, content=<a href='/topic/show?id=c42845239ef' target=_blank style='color:#2F92EE;'>#孕前#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45239, encryptionId=c42845239ef, topicName=孕前)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Sat Feb 01 07:21:00 CST 2020, time=2020-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374030, encodeId=565b3e40303f, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/V8FP2jBibt532QhxxRu9pQr9h9FqbsfJkicOvEqXCqwdQdB4xDCzbCJwTyIwbRfKaZFvO4gArNfJnkBz1CsKufjQ/132, createdBy=f13e2109202, createdName=张文英, createdTime=Thu Oct 17 08:58:01 CST 2019, time=2019-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1948109, encodeId=60b31948109ad, content=<a href='/topic/show?id=3aae55212db' target=_blank style='color:#2F92EE;'>#抗体阳性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55212, encryptionId=3aae55212db, topicName=抗体阳性)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/3239AC2A9C7E6019A0BC3C0489A21F7A/100, createdBy=c6a52500178, createdName=41514487@qq.com, createdTime=Wed Aug 28 11:21:00 CST 2019, time=2019-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=364206, encodeId=888c36420645, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Sat Apr 06 08:49:28 CST 2019, time=2019-04-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1456956, encodeId=e114145695606, content=<a href='/topic/show?id=864d48113ea' target=_blank style='color:#2F92EE;'>#左旋甲状腺素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48113, encryptionId=864d48113ea, topicName=左旋甲状腺素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=24a45820141, createdName=liuhuangbo, createdTime=Fri Apr 05 23:21:00 CST 2019, time=2019-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034778, encodeId=47451034e783e, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Apr 04 11:21:00 CST 2019, time=2019-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1046788, encodeId=49f41046e88e3, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Thu Apr 04 11:21:00 CST 2019, time=2019-04-04, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1659594, encodeId=134316595947d, content=<a href='/topic/show?id=c42845239ef' target=_blank style='color:#2F92EE;'>#孕前#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45239, encryptionId=c42845239ef, topicName=孕前)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Sat Feb 01 07:21:00 CST 2020, time=2020-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374030, encodeId=565b3e40303f, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/V8FP2jBibt532QhxxRu9pQr9h9FqbsfJkicOvEqXCqwdQdB4xDCzbCJwTyIwbRfKaZFvO4gArNfJnkBz1CsKufjQ/132, createdBy=f13e2109202, createdName=张文英, createdTime=Thu Oct 17 08:58:01 CST 2019, time=2019-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1948109, encodeId=60b31948109ad, content=<a href='/topic/show?id=3aae55212db' target=_blank style='color:#2F92EE;'>#抗体阳性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55212, encryptionId=3aae55212db, topicName=抗体阳性)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/3239AC2A9C7E6019A0BC3C0489A21F7A/100, createdBy=c6a52500178, createdName=41514487@qq.com, createdTime=Wed Aug 28 11:21:00 CST 2019, time=2019-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=364206, encodeId=888c36420645, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Sat Apr 06 08:49:28 CST 2019, time=2019-04-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1456956, encodeId=e114145695606, content=<a href='/topic/show?id=864d48113ea' target=_blank style='color:#2F92EE;'>#左旋甲状腺素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48113, encryptionId=864d48113ea, topicName=左旋甲状腺素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=24a45820141, createdName=liuhuangbo, createdTime=Fri Apr 05 23:21:00 CST 2019, time=2019-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034778, encodeId=47451034e783e, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Apr 04 11:21:00 CST 2019, time=2019-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1046788, encodeId=49f41046e88e3, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Thu Apr 04 11:21:00 CST 2019, time=2019-04-04, status=1, ipAttribution=)]
    2019-04-04 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1659594, encodeId=134316595947d, content=<a href='/topic/show?id=c42845239ef' target=_blank style='color:#2F92EE;'>#孕前#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45239, encryptionId=c42845239ef, topicName=孕前)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Sat Feb 01 07:21:00 CST 2020, time=2020-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374030, encodeId=565b3e40303f, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/V8FP2jBibt532QhxxRu9pQr9h9FqbsfJkicOvEqXCqwdQdB4xDCzbCJwTyIwbRfKaZFvO4gArNfJnkBz1CsKufjQ/132, createdBy=f13e2109202, createdName=张文英, createdTime=Thu Oct 17 08:58:01 CST 2019, time=2019-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1948109, encodeId=60b31948109ad, content=<a href='/topic/show?id=3aae55212db' target=_blank style='color:#2F92EE;'>#抗体阳性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55212, encryptionId=3aae55212db, topicName=抗体阳性)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/3239AC2A9C7E6019A0BC3C0489A21F7A/100, createdBy=c6a52500178, createdName=41514487@qq.com, createdTime=Wed Aug 28 11:21:00 CST 2019, time=2019-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=364206, encodeId=888c36420645, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Sat Apr 06 08:49:28 CST 2019, time=2019-04-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1456956, encodeId=e114145695606, content=<a href='/topic/show?id=864d48113ea' target=_blank style='color:#2F92EE;'>#左旋甲状腺素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48113, encryptionId=864d48113ea, topicName=左旋甲状腺素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=24a45820141, createdName=liuhuangbo, createdTime=Fri Apr 05 23:21:00 CST 2019, time=2019-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034778, encodeId=47451034e783e, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Apr 04 11:21:00 CST 2019, time=2019-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1046788, encodeId=49f41046e88e3, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Thu Apr 04 11:21:00 CST 2019, time=2019-04-04, status=1, ipAttribution=)]
    2019-04-04 CHANGE

    疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的

    0