甲状腺功能亢进症与妊娠期糖代谢异常

目的分析甲状腺功能亢进症（甲亢）与妊娠糖代谢异常的关系。方法对1983年1月1日-2007年12月31日在本院分娩的、孕期患有甲亢的134例孕妇（孕期甲亢组）和74例孕前有甲亢病史、孕期甲状腺功能（甲功）正常的孕妇（孕前甲亢史组），孕期糖代谢异常的情况及影响因素进行分析；并与我院同期妊娠分娩的、非甲亢的31581名孕妇（非甲亢组）进行比较。结果208例甲亢孕妇（包括孕期甲亢组和孕前甲亢史组）糖代谢异常的患病率为30．8％包括GDM7．2％，IGT3．4％和单独50g葡萄糖筛查（GCT）阳性20．2％]，显著高于非甲亢孕妇的患病率（9．4％，其中包括GDM2．8％，IGT3．0％和50gGCT阳性3．7％）（P〈0．01）。孕期甲亢组和孕前甲亢史组妇女糖代谢异常率、GDM和单独50gGCT阳性率均无统计学差异（P均〉0．05）。孕期甲亢组妇女的分娩年龄（30±4岁）和分娩前BMI（27．1±3．1）均显著低于孕前甲亢史组（分别为32±4岁，P＝0．022；28．1±3．1，P＝0．041）。结论甲亢可能是导致妊娠糖代谢异常的危险因素之一。

Hyperthyroidism and gestationai glucose metabolic abnormality

Objective To evaluate the relationship between hyperthyroidism and gestational glucose abmormality（GGA）. Methods The prevalence rate of GGA, including gestational diabetes （GDM）, gestational impaired glucose tolerance （GIGT） and 50g GCT, in 134 cases of pregnant women with hyperthyroidism and 74 cases of pregnant women with previous hyperthyroidism history and euthyroid during pregnancy were analyzed retrospectively and compared with total pregnant women without hyperthyroidism （31581 cases） between Jan. 1983 and Dec. 2007 in Peking Union Medical College Hospital. Results The prevalence of GGA in 208 women with hyperthyroidism was 30. 8% （GDM 7. 2%, IGT 3. 4%, and 50gGCT 20. 2%） ,which was significantly higher than that of 9.4%（GDM 2.8%, IGT 3.0% and 50gGCT 3.7%） in total pregnant women without hyperthyroidism at the same hosptial during the same period （P〈0. 001）. There were no differences in prevalences of GGA between women with gestational hyperthyroidism and those with previous hyperthyroidism history and gestational euthyroidisim. However, the mean age of delivery and BMI of predelivery in women with hyperthyroidism during pregnancy was significantly lower than those with previous hyperthyroidism history and gestational euthyroid （30. 3 ± 4. 2 yr, vs 31.8±4. 0 ys, P = 0. 022; 27. 1 ± 3. 1 vs 28. 1±3. 1, P=0. 041）. Conclusions Hyperthyroidism might not only increase the risk of development of preterm and low birth weight, but also increase the risk of gestational glucose abnormality, especially GDM.