再拷来一篇RIA实验室关于抗甲状腺抗体对怀孕早期失败影响的文章
Antithyroid Antibodies
In 1990, Stagnaro-Green demonstrated in a prospective analysis that thyroid antibodies were markers for "at-risk" pregnancies. The two antibodies studied, anti-thyroid peroxidase and anti-thyroglobulin antibodies, are collectively referred to as anti-thyroid antibodies (ATA). Many reports have since corroborated the markedly increased prevalence of ATA in women who experience reproductive failure, especially first trimester miscarriages. Pratt, et. al., showed that 67% of women with recurrent first trimester losses had ATA, compared to 17% of controls. None of the participants in either group had clinical manifestations of thyroid disease.
Although there is a highly positive correlation between the presence of ATA and fetal loss, no definitive pathophysiology has been identified. Several hypotheses have been proposed to explain this phenomenon. One hypothesis states that these patients have very mild hypothyroidism. Studies to date fail to indicate low thyroid hormone levels in those who miscarried. Proponents suggest that serum hormone levels do not necessarily reflect thyroid dysfunction.
Another opinion is that ATA are markers for predisposition to autoimmune disease, and that the latter is what actually causes the miscarriage. Notable is that ATA is present in up to 45% of patients with systemic lupus erythematosus (SLE). In another study, 70.8% of patients with recurrent spontaneous abortion (RSA) had various autoantibodies, leading the authors to conclude that some patients with unexplained infertility and RSA suffer from polyclonal B-cell activation.
Antithyroid antibodies appear to be markers for abnormal T-lymphocyte function. Significant increases in the endometrial T-cell population and the cytokine interferon gamma have been observed in infertile women with ATA. It can be presumed that infertile patients who demonstrate ATA can be classified as having the reproductive autoimmune failure syndrome (RAFS).
Patients with RAFS should have immune evaluations that include blocking antibodies, ANA and APA panels, NK cell number and activity, DQ alpha genotyping, and gene mutations leading to inherited thrombophilias.
Treatment for Antithyroid Antibodies
In IVF patients, antithyroid antibodies (ATAs) are treated with intravenous immune globulin (IVIg) before the IVF transfer. There is no specific treatment for ATA in patients with recurrent miscarriage unless it is associated with other abnormalities.
