促甲状腺激素轻度升高和亚临床甲状腺功能减退且TPOAb抗体阴性对妊娠期糖尿病的影响  

The association of maternal mild TSH elevation and subclinical hypothyroidism with gestational diabetes mellitus among TPOAb negative pregnant women

作　　者：苏涛 徐金辉 韩娜 计岳龙 周双 包鹤龄 刘峥 罗树生[2] 王海俊[2] SU Tao;XU Jinhui;HAN Na;JI Yuelong;ZHOU Shuang;BAO Heling;LIU Zheng;LUO Shusheng;WANG Haijun(Tongzhou Maternal and Child Health Hospital of Beijing,Beijing 101101,China)

机构地区：[1]北京市通州区妇幼保健院产科,北京101101 [2]北京大学公共卫生学院妇幼卫生学系

出　　处：《中国生育健康杂志》2022年第6期507-512,524,共7页Chinese Journal of Reproductive Health

基　　金：国家自然科学基金(81973053)。

摘　　要：目的研究甲状腺过氧化物酶抗体(TPOAb)阴性的孕妇孕早期促甲状腺激素(TSH)轻度升高和亚临床甲状腺功能减退(SCH)对妊娠期糖尿病(GDM)的影响及左旋甲状腺素(LT4)治疗的作用。方法本研究采用出生队列研究设计,数据来源于北京市通州区妇幼保健院的电子信息系统,选取末次月经在2016年5月至2019年4月之间且在北京市通州区妇幼保健院分娩的孕妇15510名,年龄在18~49岁,分娩孕周在28~42周。以研究妊娠期TSH特异性参考范围上限2.9 mIU/L为TSH参考范围上限,将研究对象分为甲状腺功能正常组(n=14787)、TSH轻度升高未治疗组(n=255)、TSH轻度升高治疗组(n=78)、SCH未治疗组(n=111)和SCH治疗组(n=279)。采用修正泊松回归模型分析TSH轻度升高和SCH未治疗组与GDM之间的关联以及LT4治疗的作用。结果以甲状腺功能正常组为参照组,TSH轻度升高未治疗组与GDM的关联没有统计学意义,SCH未治疗组增加GDM的风险(RR=1.39,95%CI:1.12~1.73,P=0.003)。以未治疗组为参照组,TSH轻度升高治疗组与未治疗组GDM的差异没有统计学意义,SCH治疗组降低GDM的风险(RR=0.54,95%CI:0.39~0.76,P<0.001)。结论孕早期TSH大于妊娠期特异性参考值范围的SCH且TPOAb阴性组增加GDM的风险,对这些孕妇进行LT4治疗能减少GDM的发生。Objective To investigate the association of maternal mild TSH elevation and subclinical hypothyroidism(SCH)in the first trimester with gestational diabetes mellitus(GDM)and the effect of levothyroxine treatment among Thyroid peroxidase antibody(TPOAb)negative pregnant women.Methods According to inclusion and exclusion criteria,a total of 15510 pregnant women were included in this birth cohort study,whose last menstrual period was between May 2016 and April 2019.Based on the upper limit of the TSH pregnancy-specific reference range(2.9mIU/L),pregnant women were divided into euthyroid(14787),untreated mild TSH elevation(n=255),treated mild TSH elevation(n=78),untreated SCH(n=111),and treated SCH(n=279)groups.Modified Poisson regression was applied to estimate the association of maternal mild TSH elevation and SCH with GDM as well as the effect of levothyroxine treatment.Results When euthyroid pregnancy women were used as the reference group,there was no association between untreated mild TSH elevation and GDM(P>0.05),while untreated SCH increased the risk of GDM(RR=1.39,95%CI:1.12-1.73,P=0.003).When untreated pregnancy women were used as the reference group,there was no significant difference between untreated and treated mild TSH elevation group,while treated SCH group was associated with a decreased the risk of GDM(RR=0.54,95%CI:0.39-0.76,P<0.001).Conclusion For TPOAb negative SCH pregnant women,an elevated level of TSH was associated with increased risk of GDM and LT4 treatment could decrease the risks.

关 键 词：孕早期 促甲状腺激素(TSH)轻度升高 亚临床甲状腺功能减退(SCH) 妊娠期糖尿病(GDM) 左旋甲状腺素(LT4) 

分 类 号：R17[医药卫生—妇幼卫生保健]