妊娠期甲状腺功能减退患者胰岛素抵抗水平及与甲状腺激素水平、妊娠结局的相关性  

Insulin resistance level and its correlation with thyroid hormone level and pregnancy outcome in patients with hypothyroidism during pregnancy

作　　者：王文杏 李云 范运娟 张巧慧 孙晓红 王晓婧 WANG Wen-xing;LI Yun;FAN Yun-juan(Department of Endocrinology,Yuncheng Central Hospital,Yuncheng Shanxi 044000,China)

机构地区：[1]运城市中心医院内分泌科,山西运城044000

出　　处：《临床和实验医学杂志》2023年第22期2416-2420,共5页Journal of Clinical and Experimental Medicine

基　　金：2022年度山西省高等学校科技创新计划项目(编号:2022L218)。

摘　　要：目的研究妊娠期甲状腺功能减退患者胰岛素抵抗水平及与甲状腺激素水平、妊娠结局的相关性。方法回顾性选取2020年5月至2022年5月于运城市中心医院进行产检并住院分娩的92例妊娠期甲状腺功能减退患者为研究对象,根据胰岛素抵抗指数(HOMA-IR)将患者分为A(HOMA-IR<4.00)、B(4.00≤HOMA-IR<5.00)、C(HOMA-IR≥5.00)3组。检测并比较各组患者促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、甲状腺过氧化物酶抗体(TPOAb)、游离甲状腺素(FT4)的表达水平。根据妊娠结局,将患者分为妊娠结局良好组和不良妊娠结局组。采用Spearman法分析妊娠期甲状腺功能减退患者HOMA-IR与TSH、FT3、TPOAb、FT4及妊娠结局的相关性。结果A组、B组、C组患者HOMA-IR及TSH、TPOAb表达水平逐渐增加,FT3、FT4表达水平逐渐降低,差异均有统计学意义(P<0.05)。妊娠期甲状腺功能减退患者HOMA-IR与TSH、TPOAb呈正相关(r=0.740、0.596,P<0.05),而与FT3、FT4呈负相关(r=-0.707、-0.650,P<0.05)。多元线性回归分析结果显示,TSH、TPOAb、FT3、FT4均是妊娠期甲状腺功能减退患者HOMA-IR的影响因素(P<0.05)。A、B、C 3组妊娠期甲状腺功能减退患者不良妊娠结局的发生率分别为30.77%、43.59%、66.67%。与妊娠结局良好组相比,不良妊娠结局组患者HOMA-IR显著升高,差异有统计学意义(P<0.05)。妊娠期甲状腺功能减退患者HOMA-IR与不良妊娠结局呈正相关(r=0.274,P<0.05)。结论妊娠期甲状腺功能减退患者HOMA-IR与TSH、TPOAb、FT3、FT4有关,TSH、TPOAb、FT3、FT4均是妊娠期甲状腺功能减退患者HOMA-IR的影响因素,HOMA-IR升高可增加患者不良妊娠结局的风险。Objective To study the level of insulin resistance in patients with hypothyroidism during pregnancy and its correlation with thyroid hormone levels and pregnancy outcomes.Methods A retrospective study was conducted on 92 patients with hypothyroidism during pregnancy who underwent prenatal examinations and were hospitalized for delivery at Yuncheng Central Hospital from May 2020 to May 2022.According to the insulin resistance index(HOMA-IR),the patients were grouped into three groups:group A(HOMA-IR<4.00),group B(4.00≤HOMA-IR<5.00),and group C(HOMA-IR≥5.00).The expression levels of thyroid stimulating hormone(TSH),free triiodothyronine(FT3),thyroid peroxidase antibody(TPOAb)and free thyroxine(FT4)in each group were detected by automatic biochemical analyzer.According to the pregnancy outcome,the patients were grouped into the good pregnancy outcome group and the adverse pregnancy outcome group;Spearman method was used to analyze the correlation of HOMA-IR with TSH,FT3,TPOAb,FT4 and pregnancy outcome in patients with hypothyroidism during pregnancy.Results The expression levels of HOMA-IR,TSH and TPOAb in groups A,B,and C gradually increased,while the expression levels of FT3 and FT4 gradually decreased,the differences were statistically significant(P<0.05).HOMA-IR was positively correlated with TSH and TPOAb in patients with hypothyroidism during pregnancy(r=0.740,0.596,P<0.05),but negatively correlated with FT3 and FT4(r=-0.707,-0.650,P<0.05).The results of multiple linear regression analysis showed that TSH,TPOAb,FT3,and FT4 were the influencing factors of HOMA-IR in patients with hypothyroidism during pregnancy(P<0.05).The incidence rate of adverse pregnancy outcomes in patients with hypothyroidism during pregnancy in groups A,B,and C was 30.77%,43.59%,and 66.67%,respectively.Compared with the good pregnancy outcome group,the HOMA-IR in the adverse pregnancy outcome group was greatly higher,the difference was statistically significant(P<0.05).HOMA-IR was positively correlated with adverse pregnancy outcomes

关 键 词：甲状腺功能减退症 甲状腺激素类 妊娠结局 胰岛素抵抗 

分 类 号：R714.256[医药卫生—妇产科学]