妊娠早期维生素D水平联合甲状腺功能及免疫炎性因子评估孕前糖尿病患者亚临床甲状腺功能减退发生的价值  

Value of vitamin D level in early pregnancy combined with thyroid function indexes and immune inflammatory factors in evaluating the occurrence of subclinical hypothyroidism in pre-gestational diabetes mellitus patients

作　　者：陈秋玲[1] 李文霞[1] Chen Qiuling;Li Wenxia(Department of Obstetrics,Changsha Hospital for Maternal and Child Health Care,Hu nan,Changsha 410007,China)

机构地区：[1]长沙市妇幼保健院产科,湖南长沙410007

出　　处：《发育医学电子杂志》2022年第3期182-188,共7页Journal of Developmental Medicine (Electronic Version)

基　　金：湖南省科技计划项目(2020SK53101)。

摘　　要：目的探讨妊娠早期维生素D水平联合甲状腺功能指标及免疫炎性因子评估孕前糖尿病(pregestational diabetes mellitus,PGDM)患者亚临床甲状腺功能减退(以下简称甲减)发生的价值。方法选取2018年9月至2020年1月期间在长沙市妇幼保健院诊断为PGDM的孕妇148例,按照维生素D水平分为维生素D缺乏组(n=86)、维生素D不足组(n=38)、维生素D充足组(n=24),分别比较三组患者甲状腺功能指标游离甲状腺素(free tthyroxine,FT4)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、促甲状腺激素(thyroid stimutating hormone,TSH)、甲状腺过氧化物酶(thyroid peroxidase antibody,TPOAb)、血清炎症因子转化生长因子-β1(transforming growth factor-β1,TGF-β1)、肿瘤坏死因子-α(tumor necrosis factor,TNF-α)等水平的差异。根据是否发生亚临床甲减,将患者分为亚临床甲减组(n=78)和单纯PGDM组(n=70),比较两组患者的临床资料,采用多因素Logistic回归分析评估影响患者发生亚临床甲减的因素,构建列线图模型,并评价其预测效能。统计学方法采用t检验、单因素方差分析、χ^(2)检验、受试者工作特征(receiver operating characteristic,ROC)、曲线下面积(area under curve,AUC)校正曲线。结果维生素D缺乏组、维生素D不足组和维生素D充足组的FT4随维生素D水平的增加而增加[(11.2±1.3)、(14.2±1.4)与(16.2±1.8)pmol/L,F=6.642],TSH[(6.2±1.2)、(4.3±1.1)与(3.4±0.7)IU/ml,F=4.743]、TPOAb[(45.5±5.2)、(31.3±3.4)与(12.4±2.6)IU/ml,F=17.004]、TGF-β1[(118.2±25.2)、(90.4±21.4)与(75.8±15.6)ng/L,F=4.143]、TNF-α[(60.2±10.3)、(54.8±9.2)与(41.3±7.9)ng/L,F=2.952]随维生素D水平的增加而降低,差异均有统计学意义(P值均<0.05)。亚临床甲减组的25羟维生素D[25 hydroxy vitamin D,25(OH)D]水平明显低于PGDM组[(13.7±3.5)与(19.2±3.4)μg/L,t=9.589],TSH[(5.9±1.4)与(3.6±1.1)mIU/L,t=5.931]、TPOAb[(43.9±17.7)与(28.3±6.4)IU/ml,t=13.344]、TGF-β1[(115.3±27.5)与(91.Objective To explore the value of vitamin D level in early pregnancy combined with thyroid function index and immune inflammatory factors in evaluating the occurrence of subclinical hypothyroidism in patients with pregestational diabetes mellitus(PGDM).Method A tatal of 148 pregnant women with PGDM diagnosed in Changsha Maternal and Child Health Hospital from September 2018 to January 2020 were divided into vitamin D deficiency group(n=86),vitamin D lack group(n=38)and vitamin D adequacy group(n=24).The level difference of thyroid function indexes on free thyroxine(FT4),free triiodothyronine(FT3),thyroid stimutating hormone(TSH),thyroid peroxidase antibody(TPOAb),transforming growth factor-β(TGF-β1)and tumor necrosis factorα(TNF-α)were compared among the three groups.According to the occurrence of subclinical hypothyroidism,patients were divided into subclinical hypothyroidism group(n=78)and simple PGDM group(n=70).The clinical data of the two groups were compared,the factors affecting the occurrence of subclinical hypothyroidism were analyzed by multivariate Logistic regression,the line chart model was constructed,and its predictive efficiency was evaluated.T test,one-way analysis of variance,χ^(2) test,receiver operating characteristic(ROC),area under curve(AUC)and correction curve were used for statistical analysis.Result FT4 of vitamin D deficiency group,vitamin D lack group and vitamin D adequacy group increased with the increase of vitamin D level[(11.2±1.3),(14.2±1.4)vs(16.2±1.8)pmol/L,F=6.642],while TSH[(6.2±1.2),(4.3±1.1)vs(3.4±0.7)IU/ml,F=4.743],TPOAb[(45.5±5.2),(31.3±3.4)vs(12.4±2.6)IU/ml,F=17.004],TGF-β1[(118.2±25.2),(90.4±21.4)vs(75.8±15.6)ng/L,F=4.143]and TNF-α[(60.2±10.3),(54.8±9.2)vs(41.3±7.9)ng/L,F=2.952]decreased with the increase of vitamin D level,and the differences were statistically significant(all P<0.05).The levels of 25(OH)D in subclinical hypothyroidism group were significantly lower than those in simple PGDM group,while the levels of TSH[(5.9±1.4)vs(3.6±1.1)mIU/

关 键 词：妊娠早期 维生素D水平 甲状腺功能指标 免疫炎性因子 孕前糖尿病 亚临床甲减 

分 类 号：R714.256[医药卫生—妇产科学]