妊娠期甲状腺功能减退合并GDM患者甲状腺功能与糖代谢水平变化  

Changes of thyroid function and glucose metabolism of pregnant women with gestational hypothyroidism complicated with gestational diabetes mellitus

作　　者：孙燕[1] 王佳盈 任倩 裴梦然 李淑文[1] SUN Yan;WANG Jiaying;REN Qian;PEI Mengran;LI Shuwen(The First Hospital of Qinhuangdao,Hebei Province,066000)

机构地区：[1]河北省秦皇岛市第一医院,066000

出　　处：《中国计划生育学杂志》2022年第8期1920-1925,共6页Chinese Journal of Family Planning

基　　金：河北省秦皇岛市科技支撑项目(202101A126)。

摘　　要：目的:分析妊娠期甲状腺功能减退合并妊娠期糖尿病(GDM)患者甲状腺功能、糖代谢水平的变化。方法:选取2018年3月—2020年10月在本院就诊的妊娠期甲状腺功能减退合并GDM患者45例(观察组),产前检查健康孕妇45例(对照组),检测血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、三碘甲腺原氨酸(T3)、四碘甲腺原氨酸(T4)水平,空腹血糖(FBG)、餐后1h血糖(PBG1h)、餐后2h血糖(PBG2h)、糖化血红蛋白(HbAlc)水平,空腹胰岛素(FINS)、餐后1h胰岛素(1hINS)水平、胰岛素抵抗指数(HOMA-IR),胰岛素、C肽水平,统计不良妊娠结局。结果:与对照组比较,观察组HbAlc水平较低,FBG、PBG1h、PBG2h、FINS、1hINS、HOMA-IR、胰岛素、C肽水平较高;观察组孕早期、孕中期、孕晚期TSH、FBG、PBG1h、FINS、1hINS逐渐降低,孕期TSH与FBG、PBG1h水平变化均呈正相关(P<0.05)。不良妊娠结局总发生率观察组(11.1%)与对照组(4.4%)未见差异(P>0.05)。结论:妊娠期甲状腺功能减退合并GDM患者甲状腺功能、糖代谢、胰岛功能发生异常,对临床诊治有一定指导意义。Objective: To analyze the changes between thyroid function of pregnant women with hypothyroidism complicated with gestational diabetes mellitus(GDM). Methods: A total of 45 pregnant women with hypothyroidism complicated with GDM were selected in observation group from March 2018 to October 2020. 45 pregnant women who underwent physical examination were selected in control group during the same time. The levels of thyroid stimulating hormone(TSH), free triiodothyronine(FT3), free thyroxine(FT4), triiodothyronine(T3), tetraiodothyronine(T4), fasting blood glucose(FBG), 1 hour postprandial blood glucose(PBG1 h),2 hours postprandial blood glucose(PBG2 h), glycosylated hemoglobin(HbAlc), fasting insulin(FINS), 1 hour postprandial insulin(1 hINS), insulin, and C-peptide(CP) of the women in the two groups were detected. The value of homeostasis model assessment of insulin resistance(HOMA-IR) of the women in the two groups was calculated. And the adverse pregnancy outcomes of the women in the two groups were counted. Results: The HbAlc level of the women in the observation group was significantly lower than that of the women in the control group, and the levels of FBG, PBG1 h, PBG2 h, FINS, 1 hINS, insulin, and CP, and the HOMA-IR value of the women in the observation group were significantly higher. In the observation group, the levels of TSH, FBG, PBG1 h, FINS, and 1 hINS of the women during the first, the second,the third trimester of pregnancy had decreased gradually, and the TSH level of the women was positively correlated with their levels of FBG and PBG1 h during pregnancy(all P<0.05). There was no significant difference in the total incidence of adverse pregnancy outcomes(11.1% vs. 4.4%) of the women between the two groups(P>0.05).Conclusion:The thyroid function,glucose metabolism,and islet function of the pregnant women with gestational hypothyroidism combined with GDM are all abnormal,which has some guiding significance in clinical diagnosis and treatment.

关 键 词：妊娠期甲状腺功能减退合并妊娠期糖尿病 甲状腺功能 糖代谢 胰岛素功能 相关性 

分 类 号：R714.256[医药卫生—妇产科学]