妊娠期糖尿病与妊娠期高血压疾病患者甲状腺功能变化情况与临床干预研究  

Study on the changes of thyroid function and clinical intervention of patients with gestational diabetes mellitus and hypertensive disorder complicating pregnancy

作　　者：叶可君 彭梦佳 戴洁[1] 丁香翠[1] 刘凌云[1] YE Ke-Jun;PENG Meng-Jia;DAI Jie(Department of Gynecology and Obstetrics, Ruian People＇s Hospital, Ruian, Zhejiang 325000, Chin)

机构地区：[1]瑞安市人民医院妇产科,浙江瑞安325000

出　　处：《中国妇幼保健》2018年第14期3142-3146,共5页Maternal and Child Health Care of China

基　　金：温州市科技计划项目(Y20170577)

摘　　要：目的回顾性分析孕早中晚期妊娠期糖尿病(GDM)和妊娠期高血压疾病(HDCP)孕妇甲状腺激素水平变化情况,探讨其与甲状腺功能的关系。方法回顾性分析2016年6月-2017年6月产科收治的GDM患者60例(GDM组),HDCP患者60例(HDCP组)的甲状腺功能变化情况,选取同期入院的正常妊娠期60例孕妇为对照组,分析孕早、中、晚期FT_4、TSH水平变化。采用多因素Logistic回归分析GDM和HDCP危险因素,采用Spearman相关分析GDM、HDCP累积发病率与甲状腺功能的关系。结果 T_3和T_4水平,孕早期GDM组和HDCP组均低于对照组(均P<0.05),孕中期GDM组低于对照组(P<0.05)。FT_3水平,孕早期GDM组和HDCP组均低于对照组(均P<0.05),孕中期HDCP组低于对照组(P<0.05)。FT_4水平,孕中期GDM组和HDCP组均低于对照组(均P<0.05)。TSH水平,孕中期和孕晚期GDM组和HDCP组均高于对照组(均P<0.05)。甲功正常而TROAb阳性发病率,孕早期GDM组和HDCP组高于对照组(P<0.05)。亚临床甲减累积发病率,孕中期和孕晚期高于对照组(P<0.05)。低T_4血症累积发病率,GDM组孕中期和孕晚期高于对照组(P<0.05),而HDCP组仅孕晚期高于对照组(P<0.05)。T_3下降0.2 nmol/L、FT_4下降0.0129 pmol/L、BMI指数>26.7 kg/m^2、TSH上升0.2 m IU/L是GDM和HDCP的独立危险因素。结论随着孕期进展,T_3、FT_4水平不断下降而TSH水平不断上升并持续到孕晚期,需持续监测T_3、FT_4和TSH变化水平。对于BMI指数>26.7 kg/m^2孕妇,孕早期应重点关注T_3水平,特别是T_3下降0.2 nmol/L;孕中期和孕晚期应重点关注FT_4、TSH变化情况,特别是FT_4下降0.012 9 pmol/L和TSH上升0.2 m IU/L时,应结合临床情况对GDM和HDCP孕妇采取预警并临床干预。Objective To retrospectively analyze the changes of thyroid function and clinical intervention of patients with gestational diabetes mellitus（ GDM） and hypertensive disorder complicating pregnancy（ HDCP） during the first,the second,and the third trimesters of pregnancy,explore the relationships with thyroid function. Methods The changes of thyroid function in 60 patients with GDM（ GDM group） and 60 patients with HDCP（ HDCP group） from Department of Obstetrics in Ruian People＇s Hospital from June 2016 to June 2017 were analyzed retrospectively. Sixty normal pregnant women during the same period were selected from the hospital as control group. The changes of free thyroxine（ FT4） and thyroid stimulating hormone（ TSH） levels during the first,the second,and the third trimesters of pregnancy were analyzed. Multivariate logistic regression analysis was used to analyze the risk factors of GDM and HDCP. Spearman correlation analysis was used to analyze the relationships between cumulative incidence rates of GDM and HDCP and thyroid function. Results The levels of T3 and T4 in GDM group and HDCP group were statistically significantly lower than those in control group during the first trimester of pregnancy（ P〈0. 05）. The levels of T3 and T4 in GDM group were statistically significantly lower than those in control group during the second trimester of pregnancy（ P〈0. 05）. The levels of FT3 in GDM group and HDCP group were statistically significantly lower than that in control group during the first trimester of pregnancy（ P〈0. 05）. The level of FT3 in HDCP group was statistically significantly lower than that in control group during the second trimester of pregnancy（ P〈0. 05）. The levels of FT4 in GDM group and HDCP group were statistically significantly lower than that in control group during the second trimester of pregnancy（ P〈0. 05）. The levels of TSH in GDM group and HDCP group were statistically significantly higher than those in control group during the second a

关 键 词：妊娠期糖尿病 妊娠期高血压疾病 甲状腺功能 预警 

分 类 号：R714.256[医药卫生—妇产科学]