甲状腺功能减退与妊娠期糖尿病相互影响的探讨

目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)与妊娠期甲状腺功能减退的相互作用及其对妊娠结局的影响。方法根据75 g口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)及甲状腺功能结果,选取2012年1月至2014年12月在南京医科大学附属南京妇幼保健院定期产检并分娩的300例孕妇的临床资料,根据患病情况分为GDM组(A组)、甲状腺功能减退组(B组)、甲状腺功能减退+GDM组(C组),每组100例。分析甲状腺功能减退对GDM者糖、脂代谢及肾功能的影响,及GDM对甲状腺功能的影响,比较3组孕妇的妊娠结局。结果 1 C组孕妇的OGTT 2 h血糖、肌酐和胆固醇水平均高于A组(P0.05),但在空腹血糖、OGTT 1 h及产后餐后2 h血糖比较,两组差异无统计学意义(P0.05);2 C组孕妇血清游离甲状腺素(free thyroxine,FT4)水平显著低于B组,差异有统计学意义(P0.05),但两组孕妇FT3、促甲状腺激素(thyroid stimulating hormone,TSH)比较,差异无统计学意义(P0.05);3 C组孕妇的胎膜早破率高于A、B组,差异有统计学意义(P0.05),而3组胎儿窘迫、产后出血、巨大儿等的发生率比较,差异无统计学意义(P0.05)。结论甲状腺功能减退可加重GDM孕妇糖、脂代谢紊乱,并损害肾功能,GDM可增加甲状腺功能减退的发生,二者相互影响。

Investigation of the interaction between hypothyroidism and gestational diabetes mellitus

Objective Toinvestigatetheinteractionbetweengestationaldiabetesmellitus(GDM)andhypothyroidismaswellas theobstetricadverseoutcomes.Methods Theclinicaldataof300pregnantwomenwhoarchivedinNanjingMaternityandChild Health Care Hospital Affiliated of Nanjing Medical University from January 2012 to December 2014 were retrospectively analyzed, with regular prenatal care were included. According to the oral glucose tolerance test ( OGTT) and thyroid function, the pregnant women were divided into three groups ( OGTT positive for group A, hypothyroidism for group B, both of them for group C ) , each group contained 100 cases. The effect of hypothyroidism on metabolism and renal function in women of GDM and the influence of GDM on thyroidfunctionandthepregnancyoutcomeswereanalyzed.Results ①OGTT2h,creatinineandcholesterolingroupCwerehigher than those of group A,the differences were statistically significant (P<0. 05), but there were no differences in fasting blood glucose (FBG), OGTT 1 h and 2 h blood glucose after delivery (P>0. 05);② Free thyroxine(FT4) in group C was lower in group B, the difference was statistically significant(P<0. 05). There were no differences in thyroid stimulating hormone(TSH) and FT3(P>0. 05) between group B and group C;③ The incidence of premature rupture of membrane( PROM) was higher in group C than the other two groups, the difference was statistically significant ( P<0. 05 ) , the differences of other pregnancy outcomes such as fetal distress, macrosomia,polyhydramnioswerenotstatisticallysignificant(P>0.05).Conclusion Hypothyroidismmayaggravatethemetabolic disorders. GDM can also increase the incidence of hypothyroidism. Both of them can increase the incidence of adverse pregnancy outcomes.