妊娠期桥本甲状腺炎患者25羟维生素D水平变化及其影响因素分析

目的　了解妊娠期桥本甲状腺炎（HT）患者25羟维生素D〔25（OH）D〕水平，并分析其影响因素。方法　选取2013年1—7月四川省医学科学院?四川省人民医院收治的符合研究标准的妊娠期HT患者102例作为HT组，考虑到日照因素的影响，依据HT组患者的入组月份匹配未患HT的妊娠妇女80例作为对照组。收集两组一般资料及甲状腺相关指标、25（OH）D水平。分析妊娠期HT患者维生素D营养状态与年龄、孕周甲状腺相关指标的关系及25（OH）D水平的影响因素。结果　HT组总甲状腺素（TT4）、总三碘甲状腺原氨酸（TT3）、游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）、25（OH）D水平低于对照组，促甲状腺激素（TSH）、甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TgAb）水平高于对照组（P<0.05）。HT组中维生素D缺乏患者FT4水平低于维生素D不足患者，TSH、TPOAb水平高于维生素D不足患者（P<0.05）。Spearman秩相关分析结果显示，妊娠期HT患者维生素D营养状态与FT4水平呈正相关（rs=0.24，P<0.05），与TSH、TPOAb水平呈负相关（rs值分别为-0.21、-0.27，P<0.05）。多元线性回归分析结果显示，FT4（t=2.002，P=0.042）、TPOAb（t=-2.981，P=0.004）水平是妊娠期HT患者25（OH）D水平的独立影响因素。结论　妊娠期HT患者25（OH）D水平明显降低，且与FT4、TPOAb水平密切相关，提示维生素D可能参与了妊娠期妇女HT的发病。

Changes in and Factors Influencing 25-hydroxyvitamin D Levels in Pregnant Women with Hashimoto Thyroiditis

Objective　To investigate the levels of 25-hydroxyvitamin D〔25（OH）D〕in pregnant women with Hashimoto thyroiditis（HT） and to analyze factors influencing those levels.Methods　One hundred and two pregnant women with HT who met the study criteria and were treated in the Sichuan Academy of Medical Sciences＆Sichuan Provincial People's Hospital between January 2013 and July 2013 were selected as the HT group.To assess the influence of sunshine exposure，80 pregnant women without HT who were admitted during the same seasons were selected as a control group.The general data，thyroid-related indicators，and 25（OH）D levels of the patients were collected.To analyze the relationship between Vitamin D nutritional status and age，gestational week thyroid related indexes in pregnant women with HT and influencing factors of 25（OH）D level.Results　The levels of TT4，TT3，FT4，FT3 and 25（OH） D in HT group were lower than those in control group，while the levels of TSH，TPOAb and TgAb in HT group were higher than those in control group（P<0.05）. In HT group，FT4 level of vitamin D deficiency patients was lower than that of vitamin D deficiency patients，TSH and TPOAb levels were higher than those of vitamin D deficiency patients（P<0.05）.Spearman rank correlation analysis showed that Vitamin D nutritional status levels were positively correlated with FT4 levels in HT patients（rs=0.24，P<0.05） and negatively correlated with the levels of TSH and TPOAb（rs=-0.21 and -0.27，P<0.05）.Multivariate linear regression showed that FT4（t=2.002，P=0.042） and TPOAb（t=-2.981，P=0.004） were independent predictive factors for 25（OH）D level in pregnant HT patients.Conclusion　25（OH）D levels in pregnant HT patients were significantly lower than those in controls and were closely related to the levels of FT4 and TPOAb，thus suggesting that vitamin D may be involved in the pathogenesis of HT in pregnant women.