中国妇幼保健

目的探讨妊娠期高血压疾病(HDCP)和妊娠期糖尿病(GDM)患者与甲状腺功能(甲功)异常的相关性,为早期有效防治提供理论依据。方法回顾性分析瑞安市人民医院200例产科门诊产前检查的GDM及HDCP患者,将纳入患者分为GDM组(140例)和HDCP组(60例);同步纳入200例门诊孕期检查与GDM和HDCP患者相比配的血糖及血压正常者为对照组。分别于孕早期(孕周8~12周)、孕中期(孕周24~28周)和孕晚期(孕周≥36周)比较3组患者血清促甲状腺激素(TSH)、游离甲状腺素(FT₄)水平,分析甲功异常的累积发病率,并探讨HDCP、GDM与甲功异常的关系。结果 GDM组孕晚期TSH水平高于对照组,孕中期FT4低于对照组,差异有统计学意义(均P<0.05)。HDCP组孕中期、孕晚期TSH水平均高于对照组,孕中期FT₄水平低于对照组,差异有统计学意义(均P<0.05)。GDM组孕中期、孕晚期亚临床甲状腺功能减低(甲减)及孕中期低T4血症累积发病率均高于对照组,孕早期甲功正常而抗甲状腺过氧化酶抗体(TPOAb)阳性发病率高于对照组,差异有统计学意义(均P<0.05)。HDCP组孕中期、孕晚期亚临床甲减及孕晚期低T₄血症累积发病率高于对照组,孕早期甲功正常而TPOAb阳性发病率高于对照组,差异有统计学意义(均P<0.05)。GDM、HDCP累积发病率与亚临床甲减、甲功正常而TPOAb阳性、低T4血症呈正相关(P<0.05)。结论相比于正常孕妇,HDCP及GDM患者TSH升高,FT4水平降低,均存在甲功异常,其中轻度甲功异常发病率较高,临床应重视此类患者甲功筛查。

Objective To explore the correlations between hypertensive disorder complicating pregnancy( HDCP),gestational diabetes mellitus( GDM) and thyroid dysfunction,provide a theoretical basis for early and effective prevention and treatment. Methods A total of200 patients with GDM and HDCP receiving prenatal examination in Obstetric Department of People's Hospital of Ruian were analyzed retrospectively,then the patients were divided into GDM group( 140 patients) and HDCP group( 60 patients). During the same period,200 women with normal blood glucose and blood pressure were selected as control group. The levels of serum thyroid stimulating hormone( TSH) and free thyroxine( FT₄) during the first trimester of pregnancy( 8-12 gestational weeks),the second trimester of pregnancy( 24-28 gestational weeks),and the third trimester of pregnancy( ≥36 gestational week) in the three groups were compared. The cumulative incidence rate of thyroid dysfunction was analyzed,the correlations between HDCP,GDM and thyroid dysfunction were discussed. Results The level of TSH during the third trimester of pregnancy in GDM group was statistically significantly higher than that in control group,while the level of FT₄ during the second trimester of pregnancy in GDM group was statistically significantly lower than that in control group( P <0. 05). The levels of TSH during the second and the third trimesters of pregnancy in HDCP group were statistically significantly higher than those in control group,while the level of FT₄ during the second trimester of pregnancy in HDCP group was statistically significantly lower than that in control group( P<0. 05). The cumulative incidence rates of subclinical hypothyroidism during the second and the third trimesters of pregnancy,low T₄ syndrome during the second trimester of pregnancy in GDM group were statistically significantly higher than those in control group,the incidence rate of thyroid dysfunction in patients with normal thyroid function and positive thyroid peroxidase antibody( TPOAb) during the first trimester of pregnancy in GDM group was statistically significantly higher than that in control group( P<0. 05). The cumulative incidence rates of subclinical hypothyroidism during the second and the third trimesters of pregnancy,low T₄ syndrome during the second trimester of pregnancy in HDCP group were statistically significantly higher than those in control group,the incidence rate of thyroid dysfunction in patients with normal thyroid function and positive TPOAb during the first trimester of pregnancy in HDCP group was statistically significantly higher than that in control group( P<0. 05). The cumulative incidence rates of GDM and HDCP were positively correlated with subclinical hypothyroidism,normal thyroid function and positive TPOAb,low T₄ syndrome( P<0. 05). Conclusion Compared with normal pregnant women,HDCP and GDM patients have higher level of TSH and lower level of FT₄,thyroid dysfunction is observed. The incidence rate of mild thyroid dysfunction is relatively high,thyroid function screening should be paid more attention among these patients.