妊娠期TPOAb阳性与流产：独立风险、与SCH的协同机制及干预策略

doi:10.12280/gjfckx.20251241

摘要/Abstract

摘要：

流产是妊娠过程中的常见并发症，发生率较高，病因复杂。甲状腺过氧化物酶抗体（thyroid peroxidase antibody，TPOAb）阳性作为流产的独立危险因素，能够借助免疫炎症、氧化应激等机制，在不依赖甲状腺功能的情况下，直接对胎盘造成损害，进而导致流产。TPOAb阳性不仅能引起亚临床甲状腺功能减退症（subclinical hypothyroidism，SCH），当两者共存时，还可通过免疫损伤与甲状腺激素不足的恶性循环显著加剧流产风险。左甲状腺素（levothyroxine，L-T₄）是治疗妊娠期SCH的主要药物，但其预防流产以及改善活产的效果仍存在争议，尤其在单纯TPOAb阳性或轻度SCH患者中获益不明确，干预时机和给药剂量也需进一步优化。未来研究需聚焦于精准风险分层和早期干预策略，为临床提供循证医学证据。

关键词: 甲状腺过氧化物酶抗体, 亚临床甲状腺功能减退症, 妊娠, 流产，自然, 左甲状腺素

Abstract:

Miscarriage is a common complication during pregnancy with a high incidence and complex etiology. Thyroid peroxidase antibody (TPOAb) positivity serves as an independent risk factor for miscarriage. It can directly damage the placenta via mechanisms such as immune inflammation and oxidative stress, independent of thyroid function, ultimately leading to miscarriage. Furthermore, TPOAb positivity can induce subclinical hypothyroidism (SCH). When they coexist, a vicious cycle of immune damage and thyroid hormone insufficiency can significantly exacerbate the risk of miscarriage. Levothyroxine (L-T₄) is the primary medication for treating SCH during pregnancy. However, its efficacy in preventing miscarriage and improving live birth outcomes remains controversial, particularly in patients with isolated TPOAb positivity or mild SCH, where the benefits are unclear. The optimal timing of intervention and dosing regimen also require further optimization. Future research should focus on precise risk stratification and early intervention strategies to provide evidence-based medical support for clinical practice.

Key words: Thyroid peroxidase antibody, Subclinical hypothyroidism, Pregnancy, Abortion, spontaneous, Levothyroxine

何曾田田, 余健楠, 高竹薇, 刘宇, 张茜, 吴效科. 妊娠期TPOAb阳性与流产：独立风险、与SCH的协同机制及干预策略[J]. 国际妇产科学杂志, 2026, 53(3): 255-260.

HE Zeng-tiantian, YU Jian-nan, GAO Zhu-wei, LIU Yu, ZHANG Qian, WU Xiao-ke. TPOAb Positivity during Pregnancy and Miscarriage: Independent Risk, Synergistic Mechanisms with SCH, and Intervention Strategies[J]. Journal of International Obstetrics and Gynecology, 2026, 53(3): 255-260.

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