妊娠期糖尿病患者的甲状腺功能和心功能状况及其妊娠结局分析  

Thyroid function,cardiac function,and pregnancy outcome in patients with gestational diabetes mellitus

作　　者：李亚妮 肖景华 贺译平 徐叶红 吴益青 王艳霞 LI Ya-ni;XIAO Jing-hua;HE Yi-ping;XU Ye-hong;WU Yi-qing;WANG Yan-xia(Department of Obstetrics and Gynecology,Northwest Women's and Children's Hospital,Xi'an 710061,Shaanxi,CHINA)

机构地区：[1]西北妇女儿童医院产二科,陕西西安710061

出　　处：《海南医学》2022年第20期2595-2598,共4页Hainan Medical Journal

基　　金：陕西省重点研发计划项目(编号:2019SF-137)。

摘　　要：目的评估妊娠期糖尿病(GDM)患者的甲状腺功能、心功能状况,并分析其妊娠结局。方法选择2020年1月至2021年1月期间西北妇女儿童医院收治的156例妊娠期糖尿病患者作为研究组。选择同期在我院体检的100例健康孕妇作为对照组。比较两组孕妇促甲状腺激素(TSH)水平、游离四碘甲状腺原氨酸(FT4)水平以及抗甲状腺过氧化物酶抗体(TPOAb)阳性率;比较两组孕妇的舒张早期三尖瓣口最大血流峰值流速/舒张晚期三尖瓣口最大血流峰值流速(E/A值)、舒张早期三尖瓣口最大血流峰值流速/三尖瓣环右心室侧壁舒张期组织多普勒运动峰值速度(E/E’值)、右室流出道短轴缩短率(RVOT-FS)、三尖瓣环右心室侧壁收缩期组织多普勒运动峰值速度(Sa)、三尖瓣环收缩期位移(TAPSE)、右心室心肌做功指数(Tei指数);比较各组孕妇的妊娠结局。结果研究组孕妇的TPOAb阳性率为26.54%,明显高于对照组的16.00%,差异有统计学意义(P<0.05),而两组孕妇TSH水平、FT4水平比较差异均无统计学意义(P>0.05);研究组孕妇的E/A比值为1.19±0.12,明显低于对照组的1.32±0.15,E/E’值为5.52±0.82,明显高于对照组的4.93±0.75,差异均有统计学意义(P<0.05);两组孕妇的的RVOT-FS、Sa、TAPSE比较差异均无统计学意义(P>0.05);研究组患者Tei指数为0.59±0.11,明显高于对照组的0.50±0.09,差异有统计学意义(P<0.05);研究组孕妇的流产和早产率为21.15%,明显高于对照组的10.00%,孕妇的足月产率为78.85%,明显低于对照组的90.00%,差异均有统计学意义(P<0.05);研究组发生新生儿窒息1例,对照组无新生儿窒息。结论GDM孕妇出现甲状腺功能异常与心功能异常的风险明显高于正常孕妇,也会在不同程度上增加妊娠不良结局风险。因此,临床应该重视孕妇特别是GDM孕妇的甲状腺疾病与心功能状况。Objective To evaluate the thyroid function and cardiac function of patients with gestational diabetes mellitus(GDM),and analyze the pregnancy outcome.Methods A total of 156 patients with gestational diabetes mellitus treated in Northwest Women's and Children's Hospital from January 2020 to January 2021 were selected as the study group.One hundred healthy pregnant women who underwent physical examination in Northwest Women's and Children's Hospital in the same period were selected as the control group.The levels of thyroid stimulating hormone(TSH),free tetraiodothyronine(FT4),and the positive rate of anti-thyroid peroxidase antibody(TPOAb)were compared between the two groups.The peak flow velocity of tricuspid valve in early diastole/peak flow velocity of tricuspid valve in late diastole(E/A value),peak flow velocity of tricuspid valve in early diastole/peak tissue Doppler velocity of right ventricular side wall of tricuspid annulus in diastole(E/E'value),short axis shortening rate of right ventricular outflow tract(RVOT-FS),peak tissue Doppler velocity of right ventricular side wall of tricuspid annulus in systole(Sa)tricuspid annular systolic displacement(TAPSE),right ventricular myocardial work index(Tei index)were compared between the two groups.The pregnancy outcomes of pregnant women were compared.Results The positive rate of TPOAb in the study group was 26.54%,which was significantly higher than 16.00%in the control group(P<0.05).There was no signif-icant difference in TSH and FT4 levels(P>0.05).The E/A ratio of pregnant women in the study group was 1.19±0.12,which was significantly lower than 1.32±0.15 in the control group,and the E/E'value was 5.52±0.82,which was signifi-cantly higher than 4.93±0.75 in the control group,with statistically significant differences(P<0.05).There was no signifi-cant difference in RVOT-FS,Sa,and TAPSE between the two groups(P>0.05).The Tei index of the study group was 0.59±0.11,which was significantly higher than 0.50±0.09 of the control group(P<0.05).The abortion and pr

关 键 词：妊娠期糖尿病 甲状腺功能 促甲状腺激素 游离四碘甲状腺原氨酸 抗甲状腺过氧化物酶抗体 心功能 妊娠结局 

分 类 号：R714.256[医药卫生—妇产科学]