Study On The Relationship Between Recurrent Abortion Of Unknown Cause And Positive Thyroid Autoantibody And Its Treatment

Objective:To explore the relationship between recurrent abortion caused by thyroid autoantibodies and the increase of NK cells.To understand whether thyroid antibody positive and elevated TSH level can further increase the number of NK cells.A retrospective analysis of pregnant RSA patients with positive thyroid autoantibodies and increased NK cell count in peripheral blood.According to the actual administration of immunosuppressant(prednisone acetate),it was divided into two groups:the group of use medicine before and after pregnancy and the group of only use medicine after pregnancy.The outcome of two groups of pregnancy was followed up to know whether the pregnancy outcome was different with the different ways of medication.Methods:We selected the patients who had two or more miscarriages in our outpatient clinic,and excluded the chromosomal abnormality,the abnormal maternal reproductive anatomy,ovarian dysfunction,rheumatoid related diseases and prethrombotic state.Observation group 1:30 cases of RSA patients with positive thyroid antibody and TSH level between 0.1-2.5m IU/L.Observation group 2:10 cases of RSA patients with positive thyroid antibody and TSH level between 2.5-4.78 m IU/L.Observation group 3:30 cases of RSA patients with negative thyroid antibody and TSH level between 2.5-4.78 m IU/L.Observation group 4:30 cases of RSA patients with negative thyroid antibody and TSH level between 0.1-2.5m IU/L.The peripheral blood NK cells were measured by flow cytometry in each group.The normal reference value of peripheral blood NK cells in the central laboratory of the first affiliated Hospital of Anyi University is 10% and 15%.Prednisone acetate was given to RSA patients with positive thyroid autoantibodies and increased NK cell count in peripheral blood(> 16.4%).Results:(1)The presence of positive thyroid antibodies increased the number of NK cells in peripheral blood and was higher than that in RSA patients with negative thyroid antibodies.(2)The levels of NK in the peripheral blood of observation group 1,2 and 3 were higher than those of observation group 4(P < 0.05).The number of cases with NK cell value > 16.4% in each group was higher than that in each group.The ratio of NK cells > 16.4% was the highest in observation group 3(100%).(3)There was no significant difference in NK cell levels between the observation 1and3 with observation 2(P > 0.05).(4)Intervention with bonisone acetate in RSA patients with positive thyroid autoantibodies and increased NK Cell count in Peripheral Blood(> 16.4%).It was found that the number of NK cells decreased obviously after taking medicine.Patients was divided into two groups:the group of use medicine before and after pregnancy and the group of only use medicine after pregnancy.Their pregnancy outcomes were followed up and the abortion rates were 13.3% and 35.3% in the two groups.There was no statistical significance between the two groups.Conclusion:(1)The number of NK cells in peripheral blood of recurrent abortion patients is increased.The results suggest that the mechanism for inducing abortion in the antibody positive patients may be related to the stimulation of more NK cells.(2)The NK value in peripheral blood of RSA patients with elevated TSH level was increased.(3)The mechanism of abortion in patients with subclinical hypothyroidism during pregnancy may be associated with increased NK cell count in peripheral blood.(4)The presence of thyroid antibody positive and TSH levels did not further increase the number of NK cells in peripheral blood.(5)Prednisone acetate can reduce the value of NK cells in peripheral blood.Prednisone was used before and after pregnancy can reduce the pregnancy abortion rate.