| Part I Study on the Distribution of TCM Syndromes of Autoimmune Thyroiditis Complicated with Infertility Objective:To investigate the distribution of different TCM syndromes in patients with autoimmune thyroiditis(AIT)complicated with infertility.Methods:By referring to the relevant literature on the distribution of different TCM syndromes of autoimmune thyroiditis and infertility in women of childbearing age,the TCM Syndromes Survey of Infertility Patients with Autoimmune thyroiditis was formulated.256 cases of infertility patients with autoimmune thyroiditis who underwent in vitro fertilization-embryo transfer(IVF-ET)assisted pregnancy at the Reproductive Center of The First Affiliated Hospital of University of Science and Technology of China from June 2019 to December 2020 were retrospectively analyzed.The data of basic information,TCM syndromes were collected.By means of frequency analysis and systematic cluster analysis,the distribution regularity of different TCM syndromes in infertility patients with autoimmune thyroiditis were concluded.Results: After analysis,the following 5 common syndrome elements were obtained,namely,spleen deficiency,liver depression,qi deficiency,kidney deficiency and blood stasis.In addition,it was concluded that this disease is more common in complex syndromes.Through systematic cluster analysis,six main TCM syndromes of this disease were obtained,which were qi deficiency and liver depression syndrome(69cases,26.9%),spleen and kidney deficiency syndrome(45 cases,17.6%),spleen qi deficiency syndrome(38 cases,14.8%),qi deficiency and blood stasis syndrome(36 cases,14.1%),kidney deficiency and liver depression syndrome(32 cases,12.5%)and other syndrome types(36 cases,14.1%).Conculsion: TCM syndromes of infertility patients with autoimmune thyroiditis can be clustered into six types,namely qi deficiency and liver depression syndrome,spleen and kidney deficiency syndrome,spleen qi deficiency syndrome,qi deficiency and blood stasis syndrome,kidney deficiency and liver depression syndrome and other types.Qi deficiency is the main syndrome element,and the sites of lesion involved spleen,kidney and liver.Blood stasis was a main pathological product.Part II Clinical Outcomes of Different TCM Syndromes of Autoimmune Thyroiditis with Infertility Undergoing in Vitro Fertilization-Embryo TransferObjective : To investigate the clinical characteristics and pregnancy outcome of infertile patients undergoing in vitro fertilization-embryo transfer(IVF-ET)with different Traditional Chinese Medicine(TCM)syndrome types of autoimmune thyroiditis(AIT),and to provide evidence of TCM treatment based on syndrome differentiation for this disease.Methods:A total of 392 infertile patients with autoimmune thyroiditis who underwent IVF-ET in the Reproductive Center of the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from June 2019 to December 2021 were collected.The characteristics of TCM syndrome types of the patients were analyzed and investigated.The general information,basic thyroid-stimulating hormone(TSH),thyroid peroxidase antibody(TPO-Ab)and thyroglobulin antibody(TG-Ab),ovulation induction index,embryo status and pregnancy outcome of each syndrome type were analyzed and compared.Results : After investigation and analysis,6 TCM syndrome types were finally determined,which were Qi deficiency and liver depression type,spleen and kidney deficiency type,spleen Qi deficiency type,Qi deficiency and blood stasis type,kidney deficiency and liver depression type and other types.Among them,Qi deficiency and liver depression type accounted for the highest proportion(26.3%).Basic TSH level was higher in Qi deficiency and liver depression,spleen Qi deficiency,Qi deficiency and blood stasis type than other syndrome types(P < 0.05).There were no significant differences among TCM syndrome types in terms of age,infertility years,infertility types and the number of transplanted embryos(P > 0.05).There were no significant differences among TCM syndrome types in thyroid antibody titer,days of ovarian stimulation,starting dose of gonadotropin(Gn),total Gn dose and retrieved oocytes(P >0.05).The analysis of indicators of embryo showed that the high-quality embryo rate of spleen-kidney deficiency type was significantly lower than that of other syndrome types(P < 0.05),and there were no significant differences in normal fertilization rate and cleavage rate among the syndrome types(P > 0.05).The analysis of pregnancy outcome showed that the early abortion rate of spleen and kidney deficiency and Qi deficiency and blood stasis were significantly higher than those of other syndrome types(P < 0.05).The clinical pregnancy rate and live birth rate were significantly lower than those of other syndrome types(P < 0.05).Conculsion:The basic TSH level in patients with Qi deficiency and liver depression,spleen Qi deficiency,Qi deficiency and blood stasis is higher than that of other syndrome types.There was no significant difference in thyroid antibody titer,the number of days of ovulation induction,the amount of Gn and the retrieved oocytes among different syndrome types.The high quality embryo rate of spleen-kidney deficiency type was significantly lower than that of other syndrome types.The early abortion rate of spleen-kidney deficiency type and Qi deficiency and blood stasis type was higher than that of other syndrome types,while the clinical pregnancy rate and live birth rate were lower than that of other syndrome types.Part III Changes in Th1/Th2/Th17 inflammatory cytokines associated with spontaneous abortion in peripheral blood of IVF-ET patients with positive thyroid antibodyObjective:The objective of this study was to observe the changes in Th1/Th2/Th17 inflammatory cytokine levels in thyroid peroxidase antibody(TPO-Ab)and/or thyroglobulin antibody(TG-Ab)positive patients who underwent first in vitro fertilization-embryo transfer(IVF-ET)assisted pregnancy,and explore its relationship with spontaneous abortion.Methods:A total of 55 TPO-Ab and/or TG-Ab positive patients who underwent IVF-ET assisted pregnancy for the first time in the reproductive center of our hospital from June 2019 to June 2021 and whose pregnancy outcome was biochemical or embryo arrest were included in the study group.55 patients with negative TPO-Ab and TG-Ab were included in the control group.The levels of Th1/Th2/Th17 inflammatory cytokines were compared between the two groups.Results The results of Th1/Th2/Th17 inflammatory cytokine detection showed that the level of IL-17 A in TPO-Ab and/or TG-Ab+ groups was significantly higher than that in control group(P < 0.05),but there was no significant difference in other cytokine levels between the two groups(P > 0.05).Conculsion: Elevated levels of IL-17 A inflammatory cytokines in TPO-Ab and/or TG-Ab+ patients treated with IVF-ET may also be associated with increased rates of spontaneous abortion. |
PDF Full Text Request