妊娠期糖尿病孕妇不同血糖指标异常与甲状腺功能变化的关系  

Thyroid Function Change in Pregnant Women with Different Types of Gestational Diabetes Mellitus

作　　者：陈爱月[1] 李婕[1] 李珠玉[2] 张琴[1] 李理[1] 何善阳[1] 游泽山[2] 刘立群[1] 

机构地区：[1]中山大学附属第一医院东院,广东广州510735 [2]中山大学附属第一医院,广东广州510120

出　　处：《中山大学学报（医学科学版）》2017年第3期443-447,共5页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】探讨妊娠期糖尿病(GDM)孕妇不同血糖指标异常与甲状腺功能变化的关系。【方法】选择2014年1月至2015年12月在中山大学附属第一医院东院规律产检并分娩妊娠期糖尿病孕妇212例,所有孕妇在孕24-28周均直接行75 g OGTT。将仅一项血糖异常为GDMⅠ(116例),两项血糖异常为GDMⅡ(61例),三项血糖异常为GDMⅢ(35例)。以同期在本院规律产检并分娩的1868例无内科合并症、产科并发症和甲状腺疾病高危因素的孕妇为对照组。所有研究对象均在入院分娩时采集空腹血,分离血清后采用化学发光免疫法检测促甲状腺素(TSH)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(TPO Ab)水平。比较两组孕妇TSH、FT4、TPO Ab水平。分别采用方差分析、Mann-Whitney U检验、Kruskal-Wallis秩和检验或Fisher精确概率法对数据进行统计学分析。【结果】GDMⅡ组孕妇TSH中位数呈升高趋势(P=0.012),FT4中位数呈降低趋势(P=0.002)。GDMⅡ组亚临床甲状腺功能减退症患病率高于对照组,差异有统计学意义(P=0.020)。GDMⅢ组亚临床甲状腺功能减退症患病率高于对照组,差异有统计学意义(P=0.013)。【结论】OGTT血糖异常项目数大于等于两项的GDM孕妇甲状腺功能异常患病率增高,并以亚临床甲减最常见。临床应对此类孕妇进行甲状腺功能全面检测,及时发现治疗甲状腺功能异常,确保孕期安全,改善妊娠结局。[ Objective ] To investigate the relationship of different types of gestational diabetes mellitus （GDM） and thyroid function. [ Methods ] A Total of 3846 cases, which received prenatal examination, delivered in the Eastern Hospital of the First Affiliated Hospital, Sun Yat-sen University and performed a 75 g oral glucose tolerance test （75 g OGTT） at 24-28 gestational weeks, from Jan 1st, 2014 to Dec 31st, 2015, were divided into 2 groups. Normal blood glucose group ： the result of OGTT （fasting plasma glucose, 1 hour glucose and 2 hour glucose ） was normal ; Gestational diabetes mellitus group （ GDM group ） ： the result of 0GTT was abnormal. GDM group were divided into Ⅰ , Ⅱ , and m. GDM Ⅰ defined as one abnormal blood glucose of result. GDM Ⅱ ： two ab- normal blood glucose. GDM Ⅲ： three abnormal blood glucose. 1868 cases of healthy pregnant women were reselected as the control group. TSH, FT4 and TPO Ab were detected in two groups. Analysis of Variance, Mann-Whitney U test, Kruskal Wallis rank test or Fisher＇s test was used for statistical analysis. [ Result] There were statistically significant difference in TSH, FT4 between GDM subgroup and control group （P = 0.012, P = 0.002）. TSH median trend to increase in GDM Ⅱ , and FT4 median trend to decrease in GDM Ⅱ. The Prevalence of hypothyroidism in GDM Ⅱ and GDM Ⅲ were higher than those in control group. [ Conclusion ] The GDM group with two or three abnormal blood glucose had a higher incidence thyroid gland dysfunction, especial with subclinical hypothyroidism. We should fully test the thyroid function, treat diabetes as early as possible and improve the pregnancy outcome as we could.

关 键 词：妊娠期糖尿病 甲状腺功能 孕妇 血糖 

分 类 号：R714[医药卫生—妇产科学]