妊娠期甲状腺功能减退与妊娠期糖尿病对妊娠结局的影响及相关性分析  

Relationship between Hypothyroidism and Gestational Diabetes Mellitus and Their Effects on Pregnancy Outcome

作　　者：景蓉[1] 李秀琴[1] 

机构地区：[1]海军总医院妇产科,北京100048

出　　处：《解放军医药杂志》2017年第8期66-71,共6页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

摘　　要：目的探讨妊娠早期甲状腺功能减退(甲减)对妊娠期糖尿病(GDM)发病率、糖脂代谢及妊娠结局的影响。方法选择2014年1月—2016年2月海军总医院收治的孕妇1865例,均于首次产检行甲状腺功能检查,孕24~28周行口服葡萄糖耐量试验(OGTT)筛查,根据检查结果将其分为正常组1538例、单纯甲减组131例、单纯GDM组168例、甲减合并GDM组28例,观察甲减对GDM发病率、糖代谢和胰岛功能、脂代谢及妊娠结局的影响。结果甲减组GDM患病率高于甲状腺功能正常组(P<0.05);甲减合并GDM组OGTT 2 h和糖化血红蛋白水平高于单纯GDM组(P<0.05);甲减合并GDM组空腹胰岛素、餐后2 h胰岛素、胰岛素抵抗指数均高于单纯GDM组,胰岛素敏感指数水平低于单纯GDM组(P<0.05);甲减合并GDM组胆固醇、甘油三酯、低密度脂蛋白胆固醇水平均高于单纯GDM组,高密度脂蛋白胆固醇低于单纯GDM组(P<0.05);单纯甲减组和单纯GDM组妊娠并发症和不良妊娠结局均明显高于正常组,且甲减合并GDM组均明显高于单纯甲减组、单纯GDM组及正常组(P<0.05);甲减合并GDM与妊娠并发症和不良妊娠结局发生率呈正相关(P<0.05)。结论孕早期甲减可增加GDM发生率,对妊娠结局有不良影响,在临床中要重视孕早期甲状腺功能筛查及血糖监测并合理干预,从而改善妊娠结局。Objective To investigate effects of hypothyroidism on incidence rate, glycolipids metabolism and pregnancy outcome of patients with gestational diabetes mellitus （GDM）. Methods A total of 1865 pregnant women admitted during January 2014 and February 2016 underwent thyroid function test in the first prenatal examination and oral glucose tolerance test （OGTT） in 24-28 gestational weeks, and the pregnant women were divided into normal group （ n = 1538 ） , simple hypothyroidism group （n = 131 ） , simple GDM group （n = 168 ） and hypothyroidism combined with GDM group （n = 28） according to inspection results. Effects of hypothyroidism on incidence rate of GDM, glycometabolism, islets of langerhans function, lipid metabolism and pregnancy outcome were observed. Results Incidence rate of GDM in simple hypothyroidism group was significantly higher than that in normal group （ P 〈 0.05 ）. OGTT 2h and glycosylated hemoglobinlevels in hypothyroidism combined with GDM group were significantly higher than those in simple hypothyroidism group （P 〈 0.05）. In hypothyroidism combined with GDM group, fasting insulin, 2 h postprandial insulin and insulin resistance index levels were significantly higher than those in simple hypothyroidism group, while insulin sensitivity index level was significantly lower than that in simple hypothyroidism group （ P 〈 0.05 ）. In hypothyroidism combined with GDM group, cholesterol, triglyceride and low density lipoprotein cholesterol levels were significantly higher, while high density lipoprotein cholesferol level was significantly lower than those in simple hypothyroidism group （P 〈 0.05）. Incidence rates of pregnancy complications and poor pregnancy outcomes were significantly higher in simple hypothyroidism and simple GDM groups than those in normal group （P 〈 0.05 ） , and the incidence rates in hypothyroidism combined with GDM group were significantly higher than those in simple hypothyroidism, simple GDM and normal groups （P 〈 0.05）. H

关 键 词：甲状腺功能减退症 糖尿病 妊娠 妊娠结局 

分 类 号：R714.256[医药卫生—妇产科学]