妊娠期糖尿病患者孕期糖化血红蛋白水平对新生儿甲状腺功能的影响  

Effect of glycated hemoglobin levels during pregnancy on neonatal thyroid function in patients with gestational diabetes mellitus

作　　者：王俊 张文蓉 樊菊香 孟珍珍 张铭 WANG Jun;ZHANG Wenrong;FAN Juxiang;MENG Zhenzhen;ZHANG Ming(Department of Clinical Laboratory,Changzhou Maternal and Child Health Care Hospital,Jiangsu Changzhou 213000,China)

机构地区：[1]常州市妇幼保健院检验科,江苏常州213000

出　　处：《中国妇幼健康研究》2023年第12期33-40,共8页Chinese Journal of Woman and Child Health Research

基　　金：常州市卫计委指导项目(WZ201822)。

摘　　要：目的探讨妊娠期糖尿病(GDM)患者糖化血红蛋白(HbA1c)与新生儿甲状腺功能的关系。方法选择2020年6月到2022年12月常州市妇幼保健院收治待产的343例合并糖尿病家族史的GDM产妇作为观察对象,根据新生儿是否发生甲状腺功能亢进,分为对照组(185例)和甲状腺功能亢进组(158例)。对比两组临床资料,采用多因素Logistic回归分析新生儿甲状腺功能亢进的影响因素,构建并验证列线图预测模型,通过X-tile软件对患者进行危险分层。结果单因素分析结果显示,甲状腺功能亢进组父母生育年龄较大、月收入较低;孕妇有流产史、职业毒物接触史、孕期使用特殊药物、孕期焦虑/抑郁占比较高、孕期被动吸烟占比较低;子代出现早产、新生儿窒息占比较高,血清HbA1c、血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平较高,高密度脂蛋白胆固醇(HDL-C)、促甲状腺激素(TSH)水平较低,差异有统计学意义(χ^(2)/t值介于3.889~134.941之间,P<0.05);多因素Logistic回归分析结果显示,母亲较高的生育年龄、HbA1c、FT3及FT4是新生儿甲状腺功能亢进的独立危险因素(OR值介于1.132~2.427之间,P<0.05),TSH水平是新生儿甲状腺功能亢进的保护因素(OR=0.661,P<0.05);依据独立影响因素构建的列线图预测模型具有较高的区分度、准确性和临床适用性;使用X-tile软件确定最佳临界值,可将患者分为三个组,依次为<162.3分(低危),≥162.3分且<204.2分(中危),≥204.2分(高危),总分越高的产妇新生儿发生甲亢的风险越高。结论GDM孕妇HbA1c水平增加为新生儿甲亢的独立影响因素,结合母亲生育年龄、TSH、FT3、FT4等构建的列线图模型可为临床提供参考。Objective To investigate the relationship between glycated hemoglobin(HbA1c)and neonatal thyroid function in patients with gestational diabetes mellitus(GDM).Methods 343 cases of GDM pregnant women with a combined family history of diabetes mellitus admitted to Changzhou Maternal and Child Health Care Hospital for delivery from June 2020 to December 2022 were selected as observation subjects,and were divided into the control group(185 cases)and the hyperthyroidism group(158 cases)according to whether or not the newborns developed hyperthyroidism.The clinical data of the two groups were compared,and the influencing factors of neonatal hyperthyroidism were analyzed by multifactorial logistic regression,the prediction model of the nomogram was constructed and validated,and the patients were risk stratified by X-tile software.Results Univariate analysis showed that in the hyperthyroidism group,parental childbearing age was higher,monthly income was lower,maternal history of miscarriage,occupational toxic exposure,use of specific medications during pregnancy,anxiety/depression during pregnancy were higher,passive smoking during pregnancy was lower,preterm birth and neonatal asphyxia in the offspring were higher,neonatal serum levels of HbA1c,triiodothyronine(T3),tetraiodothyronine(T4),free triiodothyronine(FT3),free tetraiodothyronine(FT4)were higher while high-density lipoprotein cholesterol(HDL-C),thyroid-stimulating hormone(TSH)levels were lower,the difference was statistically significant(χ^(2)/t=3.889-134.941,respectively,all P<0.05).Multifactorial logistic regression analysis showed that higher maternal childbearing age,HbA1c,FT3 and FT4 were independent risk factors for neonatal hyperthyroidism(OR=1.132-2.427,respectively,all P<0.05),and TSH level was a protective factor(OR=0.661,P<0.05).The nomogram prediction model constructed on the basis of independent influencing factors has high differentiation,accuracy and clinical applicability.Using X-tile software to determine the optimal threshold,patients were divi

关 键 词：妊娠期糖尿病 糖化血红蛋白 甲状腺功能亢进 危险因素 列线图 

分 类 号：R173[医药卫生—妇幼卫生保健]