妊娠糖尿病合并亚临床甲状腺功能减退患者补充维生素D的临床效果分析  

Clinical Effect of Vitamin D Supplementation in Patients with Gestational Diabetes Mellitus Complicated with Subclinical Hypothyroidism

作　　者：郭睿[1] 张苗苗[1] 刘冰洁 邓春霞[1] GUO Rui;ZHANG Miao-miao;LIU Bing-jie;DENG Chun-xia(Department of Gynecology and Obstetrics,Beijing Chuiyangliu Hospital,Beijing 100022,China)

机构地区：[1]北京市垂杨柳医院妇产科,北京100022

出　　处：《中国食物与营养》2021年第7期81-85,共5页Food and Nutrition in China

基　　金：北京市朝阳区科技计划项目(项目编号:CYSF181203)。

摘　　要：目的:分析维生素D水平对血糖和甲状腺功能的影响,探讨补充维生素D对妊娠糖尿病合并亚临床甲状腺功能减退患者的临床治疗效果。方法:选取2018年10月—2020年10月在本院就诊的妊娠糖尿病合并亚临床甲状腺功能减退患者(孕24~28周)142例,采用连续随机数字表法分为对照组和观察组,每组71例。对照组给予常规医学治疗,观察组在常规医学治疗的基础上补充维生素D,治疗周期均为2个月。治疗前后分别检测两组患者的空腹血糖(FPG)、糖化血红蛋白(HbA1c)、促甲状腺激素(TSH)、游离甲状腺激素(FT4)、25-羟基维生素D(25-OH-D)及血钙(Ca^(2+)),计算两组患者不良妊娠结局发生率,并作比较。结果:25-OH-D不同水平组FBG、HbA1c、TSH、血清Ca^(2+)相比较,差异具有统计学意义(P<0.01)。25-OH-D水平与FPG、HbA1c、TSH水平呈负相关,与Ca^(2+)水平呈正相关;不同水平组FT4相比较,差异无统计学意义(P>0.05)。治疗前,两组患者血糖、甲状腺、维生素D、血清Ca^(2+)各项指标比较,差异无统计学意义(P>0.05)。治疗后,两组患者血糖水平较治疗前相比明显降低,差异有统计学意义(P<0.01),且观察组FPG、餐后2 h血糖、HbA1c降低程度高于对照组,差异有统计学意义(P<0.05或P<0.01);治疗后,两组患者TSH水平较治疗前降低,FT4水平较治疗前升高,差异有统计学意义(P<0.01)。观察组TSH降低程度高于对照组,差异有统计学意义(P<0.05)。FT4升高程度与观察组相比,差异无统计学意义(P>0.05);治疗后,两组患者25-羟基维生素D(25-OH-D)、血钙(Ca^(2+))水平较治疗前明显升高,差异有统计学意义(P<0.05),且观察组25-羟基维生素D(25-OH-D)、血钙(Ca^(2+))升高程度高于对照组,差异有统计学意义(P<0.05)。治疗后,观察组早产、巨大儿和产后出血发生率低于对照组,差异有统计学意义(P<0.05);高胆红素血症和新生儿窒息发生率相比,差异无统计学意义(P>0.05);两组患【Objective】To analyze the effect of vitamin D level on blood glucose and thyroid function,and to explore the clinical effect of vitamin D supplementation on patients with gestational diabetes mellitus complicated with subclinical hypothyroidism.【Method】Totally 142 patients with gestational diabetes mellitus complicated with subclinical hypothyroidism(gestational 24~28 weeks)in our hospital from October 2018 to October 2020 were selected and randomly divided into control group and observation group with 71 cases in each group.The control group was given conventional medical treatment,and the observation group was given vitamin D on the basis of conventional medical treatment.The treatment cycle was 2 months.Fasting blood glucose(FPG),glycosylated hemoglobin(HbA1c),thyroid stimulating hormone(TSH),free thyroid hormone(FT4),25 hydroxyvitamin D(25-OH-D)and blood calcium(Ca^(2+))were detected before and after treatment in the two groups,and the incidence of adverse pregnancy outcomes in the two groups were calculated and compared.【Result】There were statistically significant differences in FBG,HbA1c,TSH and serum Ca^(2+)between the groups with different levels of 25-OH-D(P<0.01).The level of 25-OH-D was negatively correlated with FPG,HbA1c and TSH,and positively correlated with Ca^(2+)level.There was no significant difference in FT4 between different levels(P>0.05).Before treatment,there was no significant difference in blood glucose,thyroid,vitamin D and serum Ca^(2+)between the two groups(P>0.05).After treatment,the blood glucose level of the two groups was significantly lower than that before treatment(P<0.01),and the decrease degree of FPG,postprandial 2 hour blood glucose and HbA1c in the observation group was higher than that in the control group(P<0.05 or P<0.01).After treatment,the level of TSH in the two groups was lower than that before treatment,and the level of FT4 was higher than that before treatment,the difference was statistically significant(P<0.01).The decrease of TSH in the observation gr

关 键 词：妊娠糖尿病 亚临床甲状腺功能减退 维生素D 

分 类 号：R58[医药卫生—内分泌]