左旋甲状腺素对亚临床甲状腺功能减退孕妇妊娠期糖尿病发生率的影响

目的：研究左旋甲状腺素（LT4）治疗对亚临床甲状腺功能减退（SCH）孕妇中妊娠期糖尿病（GDM）发生率的影响。方法：选取经甲状腺功能筛查诊断为SCH的妊娠妇女1 084例（SCH组），正常妊娠妇女8 848例（对照组）。SCH组按患者是否愿意接受药物治疗分为SCH治疗组、SCH未治疗组，治疗组采用LT4治疗，未治疗组不用药。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）情况，并根据口服糖耐量试验（OGTT）结果，比较各组GDM发生率。结果：SCH组TSH水平高于对照组，FT4低于对照组（均P=0.000），治疗组与未治疗组的TSH水平高于对照组，FT4水平低于对照组（均P=0.000）。SCH治疗组的TSH水平与SCH未治疗组差异无统计学意义（P＞0.05）。SCH组TPOAb阳性率高于对照组（P=0.000），SCH治疗组与未治疗组的TPOAb阳性率均高于对照组（P=0.000），而SCH治疗组与未治疗组间差异无统计学意义（P＞0.05）。SCH组的GDM发生率高于对照组，差异有统计学意义（P=0.000）。SCH治疗组的GDM发生率低于未治疗组（P=0.035）。SCH治疗组的GDM发生率与对照组比较，差异无统计学意义（P＞0.05），而SCH未治疗组的GDM发生率显著高于对照组，差异有统计学意义（P＜0.01）。结论：SCH会增加GDM的发病风险，尽早使用LT4正规治疗，可能对降低SCH孕妇的GDM发生率，减少SCH合并GDM对母儿的危害有积极作用。

Influence of L-thyroxine on Incidence of Gestational Diabetes Mellitus in Gravidas with Subclinical Hypothyroidism

Objective: To estimate the influence of treatment with Ｌ－ｔｈｙｒｏｘｉｎｅ（LT4） on incidence of gestational diabetes mellitus（GDM） in pregnant women with ｓｕｂｃｌｉｎｉｃａｌ ｈｙｐｏｔｈｙｒｏｉｄｉｓｍ（SCH）. Methods: A prospective cohort study of 1 084 gravidas with SCH (SCH group) and 8 848 gravidas with normal thyroid function （ｃｏｎｔｒｏｌ ｇｒｏｕｐ） diagnosed by serum screening presented for prenatal care was performed. SCH group were divided into SCH - treated group and SCH-untreated group according to whether the patients willing to be treated with LT4. Incidences of GDM diagnosed by oral glucose tolerance test（OGTT ） in every group were compared, as well as serum levels of TSH/FT4/ｔｈｙｒｏｉｄ ｐｅｒｏｘｉｄａｓｅ ａｎｔｉｂｏｄｙ（TPOAb）. Results: Serum TSH level of SCH group was higher than control group while serum fT4 level was lower（all Ｐ=０．０00）. Serum TSH levels of either SCH-treated group or SCH-untreated group was higher than control group, while serum fT4 levels was lower （all Ｐ=０．０00）． No significant differences of TSH indicated between SCH-treated group and SCH-untreated group（Ｐ＞０．０５）. Overall positive rate of SCH group is higher than control group （Ｐ=０．０00）, and positive rate of either SCH-treated group or SCH-untreated group was higher than that of control group （P=0.000）. Positive rate of TPOAb showed no significant statistical differences between SCH-treated group and SCH-untreated group（P＞0.05）. Incidence of GDM occurred in SCH group was higher than the normal gravidas, difference was statistically significant（P=0.000）. Incidence of GDM in SCH-treated group was lower than the SCH-untreated group（P=0.035）. Incidence of GDM showed no significant differences between SCH-treated group and control group（Ｐ＞０．０５）, while incidence of GDM in SCH-untreated group was higher than control group （P＜0.01）. Conclusions: It should be paid attention to monitoring and control level of blood sugar in pregnant women with SCH because SCH increases incidence of GDM in gestation period. Using LT4 treatment as soon as possible when diagnosed as SCH after screening of thyroid function, at the same time focus on observing the changes of the blood sugar and insulin levels, as well as preventing GDM through early nutrition and exercise intervention, all above may have a positive role to improve the incidence of GDM in SCH pregnant women and reduce the dangers to mothers and children in patients of SCH combined with GDM.