背景:目前,只有一项系统评价研究了左甲状腺素(LT4)在甲状腺自身免疫正常妊娠妇女治疗中的作用,但是有些问题[,例如合并不同类型的研究进行荟萃分析,缺乏新生儿结局,等等]存在于这项研究中,不能提供满意的结果。所以,这项系统评价旨在研究LT4对甲状腺自身免疫正常妊娠妇女的影响,希望为临床使用提供更全面的证据。方法:Medline(Ovid),Embase(Ovid),从数据库开始到2022年3月,对Cochrane中央对照试验登记册进行了电子搜索。我们纳入了队列研究和RCT,评估了LT4治疗对甲状腺自身免疫正常妊娠妇女妊娠和新生儿结局的影响。不同类型研究的荟萃分析分别进行,进一步进行荟萃分析,仅纳入低和中度偏倚风险研究.我们使用了建议分级,评估,评估证据质量的开发和评估(等级)方法,并使用TSA来测试证据的充分性。结果:最后,纳入6项随机对照试验和5项队列研究中的2,901例甲状腺自身免疫正常妊娠妇女。在所有结果中,LT4组与对照组比较差异无统计学意义,包括流产[RR=0.85,95CI(0.69,1.05),p=0.14,I2=1%],早产[RR=0.80,95CI(0.59,1.08),p=0.14,I2=0%],先兆子痫[RR=0.68,95CI(0.12,3.91),p=0.66,I2=0%],胎盘早剥[Peto\'OR=0.14,95CI(0.00,6.94),p=0.32,I2=0%],出生体重[MD=-36.00,95CI(-170.41,98.41),p=0.60,I2=0%],分娩时的胎龄[MD=-0.10,95CI(-0.61,0.41),p=0.70,I2=0%]和新生儿入院[RR=1.33,95CI(0.21,8.58),p=0.76,I2=0%]。正如TSA所证明的那样,所有结果的结果都是不充分和不确定的。等级评估显示,4项结果的证据质量(流产,早产,分娩时的出生体重和胎龄)中等,和3个结果(先兆子痫,胎盘早剥和新生儿入院)低或非常低。结论:对于妊娠及新生儿结局的甲状腺功能正常妊娠合并甲状腺自身免疫,我们在这项研究中没有发现LT4治疗的益处.系统审查注册:https://www。crd.约克。AC.uk/prospro/display_record.php?ID=CRD42022346745,标识符CRD42022346745。
Background: At present, only one systematic
review has investigated the effect of levothyroxine (LT4) in the treatment of euthyroid pregnant women with thyroid autoimmunity, but some problems [such as merging different types of research for meta-analysis, lacking neonatal outcomes, and so on] exist in this study, satisfactory results can not be provided. So, this systematic
review was performed to investigate the effect of LT4 in euthyroid pregnant women with thyroid autoimmunity, in the hope of providing more comprehensive evidence for clinical use. Methods: Medline (Ovid), Embase (Ovid), and Cochrane Central Register of Controlled Trials were electronically searched from database inception to March 2022. We included cohort studies and RCTs that evaluated the impact of LT4 therapy on pregnancy and neonatal outcomes in euthyroid pregnant women with thyroid autoimmunity. Meta-analyses of different types of studies were performed separately, and meta-analyses were further performed by only including researches with low and moderate risk of bias. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to evaluate the quality of evidence, and used TSA to test the sufficiency of the evidence. Results: Finally, 2,901 euthyroid pregnant women with thyroid autoimmunity in six RCTs and five cohort studies were included. In all outcomes, no statistically significant differences were found between LT4 group and control group, including miscarriage [RR = 0.85, 95%CI (0.69,1.05), p = 0.14, I 2 = 1%], preterm birth [RR = 0.80, 95%CI (0.59,1.08), p = 0.14, I2 = 0%], preeclampsia [RR = 0.68, 95%CI (0.12, 3.91), p = 0.66, I 2 = 0%], placenta abruption [Peto\' OR = 0.14, 95%CI (0.00, 6.94), p = 0.32, I 2 = 0%], birth weight [MD = -36.00, 95%CI (-170.41, 98.41), p = 0.60, I 2 = 0%], gestational age at delivery [MD = -0.10, 95%CI (-0.61, 0.41), p = 0.70, I 2 = 0%] and neonatal admission [RR = 1.33, 95%CI (0.21, 8.58), p = 0.76, I 2 = 0%]. The results for all outcomes were insufficient and inconclusive as demonstrated by TSA. The GRADE assessments showed that the quality of evidence of 4 outcomes (miscarriage, preterm birth, birth weight and gestational age at delivery) were moderate, and 3 outcomes (preeclampsia, placenta abruption and neonatal admission) were low or very low. Conclusion: For pregnancy and neonatal outcomes in euthyroid pregnant women with thyroid autoimmunity, we did not find benefit of LT4 treatment in this study. Systematic
Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022346745, identifier CRD42022346745.