徐亚新,任玉环

子宫内膜异位症（Endometriosis,EM）与自身免疫性甲状腺疾病（Autoimmune Thyroid Diseases,AITD）均为影响育龄期女性身心健康的常见慢性疾病，近20年来，越来越多的研究发现两者在发病机制、免疫炎症反应及临床特征上存在潜在关联。本文通过系统梳理近年国内外相关文献，总结了EM与AITD在自身抗体变化、免疫病理机制及遗传易感性等方面的研究进展。研究表明，EM患者中AITD相关抗体（如甲状腺过氧化物酶抗体、甲状腺球蛋白抗体）的阳性率显著升高，提示两者可能共享相似的免疫调节异常。此外，甲状腺抗体水平与子宫内膜异位症病灶大小、临床症状及治疗反应的相关性逐渐被揭示。但当前研究可能因样本量较小影响统计效能；研究多采用横断面设计无法确定因果关系；抗体检测未涵盖所有潜在交叉抗原等为两疾病之间的研究带来诸多挑战。未来深入解析抗体介导的免疫损伤机制、开发基于抗体检测的早期筛查策略，以及探索免疫调节治疗的临床应用，可为理解两种疾病的发病机制提供新视角，也为临床精准诊疗提供新的理论依据。

子宫内膜异位症；自身免疫性甲状腺疾病；甲状腺功能异常；抗体变化；免疫机制；研究进展

[1] Peyneau M,Kavian N,Chouzenoux S,Nicco C,Jeljeli M,Toullec L,Reboul-Marty J,Chenevier-Gobeaux C,Reis FM,Santulli P,Doridot L,Chapron C,Batteux F.Role of thyroid dysimmunity and thyroid hormones in endometriosis.Proc Natl Acad Sci U S A.2019 Jun 11;116(24):11894-11899. [2] Agnes Svensson,Bodil Roth,Linnea Kronvall,Bodil Ohlsson,TSH receptor antibodies(TRAb)–A potential new biomarker for endometriosis,European Journal of Obstetrics&Gynecology and Reproductive Biology,Volume 278,2022,Pages115-121,ISSN0301-2115 [3] Uehara,M.,Wada-Hiraike,O,Hirano,M.et al.Relationship between bone mineral density and ovarian function and thyroid function in perimenopausal women with endometriosis:a prospective study.BMC Women's Health 22,134(2022). [4] Moldassarina,R.S.,Manabayeva,G.K.,Akylzhanova,Z.Y.et al.Retraction Note:The importance of vitamin D in the diagnosis and treatment of adenomyosis.Mol Cell Biochem 479,1549(2024). [5] Tao Zhang,Caterina De Carolis,Gene Chi Wai Man,Chi Chiu Wang,The link between immunity,autoimmunity and endometriosis:a literature update,Autoimmunity Reviews,Volume 17,Issue 10,2018,Pages 945-955,ISSN 1568-9972 [6] 易宇霞,曹玉梅.子宫内膜异位症与自身免疫性甲状腺疾病的研究进展[J].邵阳学院学报(自然科学版),2024,21(05):99-104. [7] Peyneau,N.Kavian,S.Chouzenoux,C.Nicco,M.Jeljeli,L.Toullec,J.Reboul-Marty,C.Chenevier-Gobeaux,F.M.Reis,P.Santulli,L.Doridot,C. Chapron, &F.Batteux,Role of thyroid dysimmunity and thyroid hormones in endometriosis,Proc.Natl.Acad.Sci.U.S.A.116(24)11894- 11899, (2019). [8] 罗佳坤.自身免疫性甲状腺疾病与卵巢子宫内膜异位症相关性的研究[D].中国医科大学,2022. [9] 王祎祎,汪沙,段华.自身免疫性甲状腺疾病与子宫内膜异位症的相关性研究进展[J].中华妇产科杂志,2020,55(02):138-141. [10] Bancsi LF,et al.Vitamin D status and ovarian reserve markers in women undergoing in vitro fertilization.Fertil Steril.2013; 100(4):1033-1040. [11] Poppe Kris,Glinoer Daniel,Van Steirteghem Andre et al.Thyroid dysfunction and autoimmunity in infertile women.[J].Thyroid, 2002,12:997-1001. [12] Sinaii N,Cleary SD,Ballweg ML,et al.High rates of autoimmune and endocrine disorders,fibromyalgia,chronic fatigue syndrome and atopic diseases among women with endometriosis:a survey analysis.Hum Reprod.2002;17(10):2715-2724. [13] Vieira IH,Rodrigues D,Paiva I.Vitamin D and Autoimmune Thyroid Disease-Cause,Consequence,or a Vicious Cycle?Nutrients.2020 Sep 11;12(9):2791. [14] Brčić,L.,Barić,A.,Gračan,S.et al.Genome-wide association analysis suggests novel loci underlying thyroid antibodies in Hashimoto’s thyroiditis.Sci Rep 9,5360(2019). [15] Association of CTLA4(rs4553808)and PTPN22(rs2476601)gene polymorphisms with Hashimoto's thyroiditis disease:A case-control study and an In-silico analysis [16] G.Izumi et al.,Involvement of immune cells in the pathogenesis of endometriosis.J.Obstet.Gynaecol.Res.44,191–198 [17] Peyneau M,Kavian N,Chouzenoux S,et al.Role of thyroid dysimmunity and thyroid hormones in endometriosis.Proc Natl Acad Sci U S A.2019 Jun 11;116(24):11894-11899. [18] ZAHIDM,GOLDNERW,BESELERCL,etal.Unbalancedestrogenmetabolisminthyroidcancer[J].InternationalJournalofCancer,2013,133 (11):2642-2649. [19] SAAVALAINENL,LASSUSH,BUTA,etal.ANationwideCohortStudyontheriskofnongynecologicalcancersinwomenwithsurgicallyverif- iedendometriosis[J].InternationalJournalofCancer,2018,143(11):2725-2731.PMC6575600. [20] Şerifoğlu H,Arinkan SA,Pasin O,Vural F.Is there an association between endometriosis and thyroid autoimmunity?Rev Assoc Med Bras(1992).2023 May 29;69(6):e20221679. [21] Petta CA,Arruda M S,Zantut-Wittmann DE et al.Thyroid autoimmunity and thyroid dysfunction in women with endometriosis.[J].Hum Reprod,2007,22.

点击下载PDF