甲状腺特异性抗体联合抗米勒管激素对促甲状腺激素正常的多囊卵巢综合征不孕患者妊娠结局的预测价值

Predictive value of thyroid specific antibody combined with anti-Müllerian hormone level on pregnancy outcome in infertile patients with normal TSH polycystic ovary syndrome

摘要:

目的 探讨甲状腺特异性抗体联合抗米勒管激素（AMH）对促甲状腺激素（TSH）正常的多囊卵巢综合征（PCOS）不孕患者妊娠结局的预测价值。方法 选取2020年9月—2021年9月上海儿童医学中心三亚市妇女儿童医院收治的TSH正常的PCOS不孕患者72例为研究对象，根据是否妊娠分为妊娠组21例和未妊娠组51例。比较两组的一般资料及甲状腺特异性抗体［甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TGAb）及AMH水平；采用多因素Logistic回归分析妊娠结局的影响因素；绘制ROC曲线分析甲状腺特异性抗体联合AMH对妊娠结局的预测效能。结果 两组的年龄、BMI、PCOS病程、不孕年限、家族史、TSH水平、性激素水平比较，差异无统计学意义（P >0.05）；妊娠组PCOS病情程度等级分布优于未妊娠组（P <0.05）；妊娠组TPOAb、TGAb、AMH水平低于未妊娠组（P <0.05）。经多因素Logistic回归分析，PCOS病情程度［O^R=3.422（95% CI：1.287，9.098）］、TPOAb［O^R=3.932（95% CI：1.765，8.758）］、TGAb［O^R=3.884（95% CI：1.903，7.926）］、AMH［O^R=5.695（95% CI：2.879，11.265）］均为妊娠结局的影响因素（P <0.05）。经ROC分析显示，TPOAb、TGAb、AMH预测妊娠结局的截断值分别为77.89 IU/mL、17.38 IU/L、5.90 ng/mL，敏感性分别为80.95%（95% CI：0.574，0.937）、76.19%（95% CI：0.525，0.909）、52.38%（95% CI：0.303，0.736），特异性分别为72.55%（95% CI：0.580，0.837）、78.43%（95% CI：0.643，0.882）、98.04%（95% CI：0.882，0.999），AUC分别为0.823（95% CI：0.715，0.903）、0.824（95% CI：0.717，0.904）、0.753（95% CI：0.637，0.847）；联合预测的敏感性为95.24%（95% CI：0.741，0.998）、特异性为94.12%（95% CI：0.828，0.985），AUC为0.955（95% CI：0.879，0.990）。结论 甲状腺特异性抗体、AMH水平对TSH正常PCOS不孕患者妊娠结局具有一定预测价值，可为临床诊治提供重要参考。

Abstract:

Objective To study the predictive value of thyroid specific antibody combined with anti-Müllerian hormone (AMH) level on pregnancy outcome in infertile patients with normal thyroid-stimulating hormone (TSH) and polycystic ovary syndrome (PCOS).Methods Seventy-two patients with normal TSH and PCOS infertility in our hospital from September 2020 to September 2021 were divided into pregnancy group (n = 21) and non pregnancy group (n = 51). The general data of the two groups and the levels of thyroid specific antibodies [thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TGAb)] and AMH were compared. The influencing factors of pregnancy outcome were analyzed by logistic regression, and the predictive value of thyroid specific antibody combined with AMH was analyzed by ROC curve.Results There was no significant difference in age, BMI, course of PCOS, years of infertility, family history, TSH level, and sex hormone level between the two groups (P > 0.05). The grade distribution of PCOS in pregnant group was better than that in non pregnant group (P < 0.05). The levels of TPOAb, TGAb, and AMH in pregnant group were lower than those in non pregnant group (P < 0.05). Logistic regression analysis showed that the degree of PCOS [O^R = 3.422 (95% CI: 1.287, 9.098) ], TPOAb [O^R = 3.932 (95% CI: 1.765, 8.758) ], TGAb [O^R = 3.884 (95% CI: 1.903, 7.926) ] and AMH [O^R = 5.695 (95% CI: 2.879, 11.265) ] were the influencing factors of pregnancy outcome (P < 0.05). The ROC analysis showed that the cut off values of TPOAb, TGAb, and AMH in predicting pregnancy outcome were 77.89 IU/mL, 17.38 IU/L, and 5.90 ng/mL, the sensitivity was 80.95% (95% CI: 0.574, 0.937), 76.19% (95% CI: 0.525, 0.909), 52.38% (95% CI: 0.303, 0.736), and the specificity was 72.55% (95% CI: 0.580, 0.837), 78.43% (95% CI: 0.643, 0.882), 98.04% (95% CI: 0.882, 0.999). The sensitivity of combined prediction was 95.24% (95% CI: 0.741, 0.998), the specificity was 94.12% (95% CI: 0.828, 0.985), and the AUC value was 0.955 (95% CI：0.879，0.990).Conclusion Thyroid specific antibody and AMH level have certain predictive value for pregnancy outcome of infertile patients with PCOS with normal TSH, and can provide important reference value for clinical diagnosis and treatment.