妊娠期糖尿病与妊娠期甲状腺功能状态的相关性分析

摘要

目的 观察妊娠期血糖水平与甲状腺功能的相关性,探讨GDM是否与妊娠期甲状腺功能异常相关.方法 选取在我院产检的孕妇514名,分为GDM组与非GDM组.收集妊娠期血清游离甲状腺激素(FT4)、促甲状腺激素(TSH)、甲状腺过氧化物酶抗体(TpoAb)、75 g OGTT结果,统计GDM、甲状腺功能异常的发病率,比较两组甲状腺功能异常的差异,分析FT4、TSH与血糖水平的相关性.结果 总甲状腺功能异常发病率为21.2%,其中临床甲状腺功能亢进、亚临床甲状腺功能亢进、临床甲状腺功能减退、亚临床甲状腺功能减退发病率分别为3.7%、1.9%、0.2%、15.4%,TpoAb阳性率为9.7%,GDM的发病率为16.3%;GDM组与非GDM组甲状腺功能异常、TpoAb阳性率比较,差异均无统计学意义(X2=0.407、1.051,P=0.523、0.305);妊娠早期TpoAb阳性组与阴性组的GDM发病率比较,差异有统计学意义(X2=6.362,P=0.012),而中晚期则差异无统计学意义;FT4仅与FPG呈负相关(r=-0.148,P=0.001),TSH与FPG、1 hPG及2 hPG无相关性.结论 GDM与甲状腺功能异常无相关性,但妊娠早期TpoAb阳性与GDM发病可能存在一定的相关性.%Objective To investigate the correlation between serum blood glucose levels and thyroid function in subjects with pregnancy,and to discuss ifgestational diabetes mellitus(GDM) was associated with thyroid dysfunction.Methods A total of 514 pregnant women takingantenatal examination in our hospital were enrolled in this study and divided into GDM group and non GDM group.Serum free thyroid hormone(FT4),thyroid stimulating hormone (TSH),and thyroid peroxidase antibody (TpoAb) were measured during pregnancy,and 75 g OGTT were performed in all the subjects.The incidence of GDM and abnormal thyroid function were calculated.The difference of abnormal thyroid function was compared between the two groups.The correlations between FT4,TSH and blood glucose levels were analyzed.Results The incidence of thyroid dysfunction,clinical hyperthyroidism,subclinical hyperthyroidism,clinical hypothyroidism,subclinical hypothyroidism was 21.2%,3.7%,1.9%,0.2% and 15.4%,respectively.The positive rate of TpoAb was 9.7%.The incidence of GDM was 16.3%.The incidence of gestational thyroid dysfunction and TpoAb positive rate(X2=0.407,1.051,P=0.523,0.305)were similar between the two groups.The incidence of GDM was significantly different between TpoAb positive and TpoAb negative subjects in women with early pregnancy (X2=6.362,P=0.012),but non-significantly different in women with middle or late pregnancy.FT4 was only associated with fasting plasma glucose (r=-0.148,P=0.001).TSH was not associated with blood glucose in any of the three time points.Conclusion There is no significant association between GDM and thyroid dysfunction.But positive TpoAb may be associated with GDM in early pregnancy.