不同时期 GDM 和妊娠期高血压患者甲状腺功能异常的关系

目的：探讨不同孕期妊娠期糖尿病和妊娠期高血压患者与甲状腺功能异常的相关性。方法回顾分析480例孕妇临床资料，其中96例妊娠期糖尿病为糖尿病组，52例妊娠期高血压分为高血压组，332例正常孕妇分为对照组。统计3组孕妇的游离甲状腺素（FT4）水平、促甲状腺激素（TSH）水平，比较二者在孕早期、孕中期、孕晚期的变化趋势及平均水平。分析3组孕妇的各类甲状腺功能异常以及轻度甲状腺功能异常的发病情况。结果孕中期的FH4水平，糖尿病组和高血压组均比对照组低（ P ﹤0.05）；孕中期的 FT4下降率，糖尿病组较对照组高（ P ﹤0.05）；孕中期的 TSH 水平，高血压组较对照组高（ P ﹤0.05）；孕晚期的 TSH 水平，糖尿病组和高血压组均较对照组高（ P ﹤0.05）；3组孕妇 TSH 平均水平随着孕期增加呈上升趋势，但差异无统计学意义（ P ﹥0.05）。孕晚期，累计的临床甲亢发病率、临床甲减、亚临床甲亢在3组间差异无统计学意义（ P ﹥0.05）；累计的亚临床甲减发病率，糖尿病组和高血压组比对照组均高（ P ﹤0.05）；累计的低 T4血症发病率，糖尿病组和高血压组均比对照组高（ P ﹥0.05）；孕晚期，轻度甲状腺功能异常发生率在糖尿病组比对照组高（ P ﹥0.05），而高血压组与对照组之间差异无统计学意义（χ2＝3.82，P ＝0.096）。结论相较于正常孕妇，妊娠期高血压及妊娠期糖尿病患者具有更高的 TSH、更低的 FT4水平和较高的轻度甲状腺功能异常的发病率，临床上对这些患者的甲状腺功能情况应该给予更多的关注和检测。

The correlation between thyroid function abnormality and gestational diabetes mellitus as well as gestational hypertension at different pregnant periods

Objective To investigate correlation between thyroid function abnormality and gestational diabetes mellitus as well as gestational hypertension at different pregnant periods. Methods The clinical data of 480 pregnant women were retrospectively analyzed in which 96 cases of gestational diabetes were served as diabetes group,52 cases of gestational hypertension were served as hypertension group,and 332 normal pregnant women were regarded as control group. The levels of free thyroxine( FT4)and thyroid stimulating hormone( TSH)of pregnant women in the three groups were statistically analyzed,and the levels and change trend of FT4 and TSH at early gestation,mid-gestation,late-gestation were analyzed and compared among groups. Furthermore different kinds of abnormal thyroid function abnormalities were statistically analyzed. Results The FH4 levels at mid-gestation in diabetes group and hypertension group were significantly lower than those in control group( P ﹤ 0. 05),moreover,the decrease rate of FT4 at mid-gestation in diabetes group was significantly higher than that in control group( P ﹤ 0. 05). The levels of TSH at mid-gestation in diabetes group were significantly higher than that in control group( P ﹤ 0. 05). However the levels of TSH at late-gestation in diabetes group and hypertension group were significantly higher than those in control group( P ﹤ 0. 05). With the pregnant duration went on,there was a increase trend in TSH levels,but there was no significant difference in increasing degree among the three groups( P ﹥ 0. 05). There were no significant differences in integrating incidence rates of clinical hyperthyroidism, clinical hypothyroidism,sub-clinical hyperthyroidism at late-gestation among three groups( P ﹥ 0. 05). However integrating incidence rates of sub-clinical hypothyroidism in diabetes group and hypertension group were significantly higher than those in control group( P ﹤ 0. 05), moreover,integrating incidence rates of low T4emia in diabetes group and hypertension group were significantly higher than those in control group( P ﹤ 0. 05). At late-gestation,the incidence rates of mild thyroid dysfunction in diabetes group were significantly higher than those in control group( P ﹤ 0. 05),however,there were no significant differences between diabetes group and control group( P ﹥ 0. 05). Conclusion As compared with normal pregnant women,the patients with gestational hypertension or gestational diabetes have higher levels of TSH,lower levels of FT4 and higher incidence rates of mild thyroid dysfunction. Therefore,we should pay much attention to the detection of thyroid function of these patients.