亚临床甲状腺功能减退对妊娠期糖尿病发病及其妊娠结局的影响

摘要

目的：研究亚临床甲状腺功能减退（SCH）对妊娠期糖尿病（GDM）发病及妊娠结局的影响。方法：选取经甲状腺功能筛查诊断为SCH的妊娠妇女342例（SCH组）和正常妊娠妇女2605例（对照组），根据75 g口服糖耐量试验（OGTT）结果比较2组GDM发病率，每组再分为GDM组及OGTT正常组，比较各组促甲状腺素（TSH）、游离甲状腺素（FT4）、甲状腺过氧化物酶抗体（TPOAb）、妊娠结局及新生儿体格参数。结果：SCH组GDM发生率高于对照组（P＜0.01）。SCH组TPOAb阳性率、TSH水平和FT4水平与对照组，差异有统计学意义（均P＜0.01），而在SCH组和对照组的2个亚组间差异均无统计学意义（P＞0.05）。 SCH组和对照组的流产、早产率和分娩时间差异均有统计学意义（P＜0.01）；组间两两比较显示，SCH-GDM组流产、早产率高于SCH-OGTT正常组及对照组，SCH-OGTT正常组高于对照-OGTT正常组，对照-GDM组高于对照-OGTT正常组；SCH组2个亚组间分娩时间差异无统计学意义（P＞0.05），但均小于对照组2个亚组（P＜0.01）。新生儿体质量、头围和身高等体格参数，各组间差异无统计学意义。结论：SCH会增加GDM发病及妊娠不良结局的风险，SCH合并GDM危害高于单一疾病，应注重对SCH妊娠妇女血糖的监测和控制。%Objective:To explore differences in incidence of gestational diabetes mellitus (GDM) and pregnancy outcomes for patients with subclinical hypothyroidism (SCH) versus normal pregnant women. Methods:A retrospective chart review of 342 pregnant women with SCH(SCH group) and 2 605 pregnant women with normal thyroid function(control group) diagnosed by serum thyroid function screening presented for prenatal care was performed. The incidences of GDM diagnosed by oral glucose tolerance test (OGTT) of two groups were compared. Each group was divided into GDM&normal OGTT subgroups by results of OGTT, the following parameters of every subgroup were abstracted and appropriate statistical tests were performed:serum levels of TSH/FT4/TPOAb, incidences of abortion and premature delivery, the average weeks of delivery, the weights/lengths/head circumferences of neonates. Results:SCH group developed higher incidence of GDM than control group. Frequencies of TPOAb positivity were higher in SCH group than control group, while no significant differences were indicated between SCH subgroups neither was between control subgroups(P<0.01). Serum TSH level of SCH group was higher than control group while serum FT4 level was lower(P<0.01), while no significant differences of TSH and T4 levels were indicated between SCH subgroups neither were between control subgroups(P>0.05). Incidence of abortion and premature delivery in SCH-GDM subgroup was significant higher than rates in SCH-normal OGTT subgroups and both control subgroups(P<0.01). The rate was higher in SCH-normal OGTT subgroup than in control-normal OGTT subgroup (P<0.01) as well as in control-GDM subgroup than control-normal OGTT subgroup (P<0.05), while no significance difference was showed between subgroups SCH-normal OGTT and control-GDM (P>0.05). No statistical difference of the average weeks of delivery was found between SCH subgroups (P>0.05), while both were shorter than weeks of control subgroups(P<0.01). No differences were indicated in the weights/lengths/head circumferences of neonates. Conclusions: SCH increases incidence of GDM in gestation period, Risk of adverse pregnant outcomes is higher when SCH complicated with GDM because it′s more harmful than simple disease. SCH patients should be observed emphatically, specially in monitoring and controlling levels of blood sugar.