目的:本研究的目的是探讨甲状腺自身抗体(TGAb和TPOAb)与早期流产漏诊患者绒毛膜组织X染色体单体的关系。
方法:基线数据,甲状腺功能,对228例漏诊早期流产患者的甲状腺抗体和绒毛膜组织的染色体进行了检查。
结果:(1)在228例患者中,121号染色体数目正常,和107个染色体数目异常。大部分是常染色体三体性,其中以16三体(40.19%)为主。性染色体单体(28.04%)为继发性。(2)228例患者中,本研究208例患者甲状腺功能正常(其中甲状腺抗体阴性134例,单纯甲状腺抗体阳性74例);6例患者甲状腺功能异常(其中临床甲亢2例,3例亚临床甲状腺功能减退症,1例低甲状腺素血症);14例患者仅TSH正常和T4升高。(3)排除甲状腺功能异常患者后,正常染色体组与异常染色体组的基线资料差异无统计学意义(P>0.05)。然而,正常染色体和异常染色体组的TGAb和TPOAb在45,X核型之间存在显着差异,45,X核型组中TGAb和/或TPOAb阳性比例较高(P<0.05)。此外,与TGAb和/或TPOAb阳性患者相比,TGAb和TPOAb阴性患者发生X染色体单倍体的风险明显降低(P<0.05)。此外,X染色体单体组的TGAb和TPOAb滴度值均高于染色体正常组(P<0.05)。
结论:TGAb之间存在相关性,早期流产漏诊患者绒毛膜组织中的TPOAb和X染色体单倍体,尽管机制仍有待进一步研究。
OBJECTIVE: The aim of this study was to investigate the relationship between thyroid autoantibodies (TGAb and TPOAb) and X chromosome
monosomy in the chorionic tissue of patients with missed early miscarriage.
METHODS: The baseline data, thyroid function, thyroid antibody and the chromosomes from the chorionic tissue of 228 patients with missed early miscarriage were examined.
RESULTS: (1) Among the 228 patients, 121 had a normal chromosome number, and 107 had an abnormal chromosome number. The majority of them were autosomal trisomy, of which trisomy 16 (40.19%) was predominant. Sex chromosome
monosomy (28.04%) was secondary. (2) Among the 228 patients, 208 patients in this study had normal thyroid function (including 134 cases of negative thyroid antibodies and 74 cases of positive thyroid antibodies alone); 6 patients had abnormal thyroid function (including 2 cases of clinical hyperthyroidism, 3 cases of subclinical hypothyroidism, 1 case of hypothyroxinemia); and 14 patients had normal TSH and elevated T4 alone.(3) After exclusion of patients with thyroid function abnormalities, there were no significant differences in baseline data between the normal chromosome group and the abnormal chromosome group (P > 0.05). However, there was a significant difference in TGAb and TPOAb between the normal chromosome and abnormal chromosome group with 45, X karyotype, with a higher proportion of TGAb and/or TPOAb positivity in the 45, X karyotype group (P < 0.05). Additionally, compared to TGAb and/or TPOAb-positive patients, the risk of X chromosome
monosomy was significantly reduced in TGAb and TPOAb-negative patients (P < 0.05). Moreover, both TGAb and TPOAb titer values in the X chromosome
monosomy group were higher than those in the chromosomally normal group (P < 0.05).
CONCLUSIONS: There is a correlation between TGAb, TPOAb and X chromosome
monosomy in the chorionic tissue of patients with missed early miscarriage, although the mechanism remains to be further investigated.