妊娠期糖尿病患者的糖化血红蛋白及维生素D水平与新生儿TSH水平的相关性研究
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摘要
目的探讨妊娠期糖尿病(GDM)孕妇不同的血糖控制水平和25-羟维生素D水平与其新生儿促甲状腺激素(TSH)水平的相关性。方法选取2017年在该院产科住院的已明确诊断为GDM的晚期妊娠孕妇150例作为观察组,另选取健康孕妇150例作为对照组。收集两组孕妇的临床资料,包括年龄和体质量等基本资料,除常规产前检查外,检测两组孕妇的甲状腺功能(FT_3、FT_4、TSH)、单纯甲状腺抗过氧化物酶(TPOAb)水平、糖化血红蛋白水平及25-羟维生素D水平,两组孕妇分娩后,取新生儿的足跟血,检测新生儿的FT_3、FT_4、TSH水平。结果与对照组比较,观察组孕妇糖化血红蛋白水平明显高于对照组(P<0. 05),25-羟维生素D水平明显低于对照组(P<0. 05)。观察组孕妇分娩的新生儿甲状腺FT_3和FT_4水平明显低于对照组,TSH水平明显高于对照组(P<0. 05)。GDM孕妇糖化血红蛋白与其新生儿甲状腺TSH水平呈正相关,GDM孕妇25-羟维生素D水平与其新生儿甲状腺TSH水平呈负相关(P<0. 05)。结论 GDM孕妇血糖控制越差,维生素D水平越低,可能与新生儿甲状腺TSH水平密切相关,提示孕期血糖控制及维生素D补充十分重要。
Objective To explore the correlation between different blood glucose control levels and 25-hydroxyvitamin D levels in GDM pregnant women and their neonatal thyroid TSH levels. Methods Selected 150 cases of pregnant women with gestational diabetes mellitus as observation group,150 healthy pregnant women were selected as control group. Collected clinical data of two groups of pregnant women,the basic information including age and weight. In addition to routine prenatal examination,the thyroid function of two groups was detected( FT_3、FT_4、TSH、TPOAb),the level of Hb A1 c and 25-hydroxyvitamin D. After delivery of the two groups,the newborn's heel blood was taken to detect the thyroid function of the newborn( FT_3、FT_4、TSH). Results When compared with the control group,the glycosylated hemoglobin level in the observation group was significantly higher than that in the control group( P < 0. 05),and the 25-hydroxyvitamin D level in the observation group was significantly lower than that in the control group( P<0. 05). The level of FT_3 and FT_4 in the Newborns of the observation group were lower than that of the control group,and the level of TSH was significantly higher than that of the control group. The level of glycosylated hemoglobin in pregnant women with diabetes is positively correlated with the level of neonatal thyroid TSH. There is a negative correlation between the level of 25-hydroxyvitamin D pregnant women with diabetes mellitus and the level of thyroid TSH in neonates( P<0. 05). Conclusion The poorer blood glucose control in diabetic pregnant women,the lower vitamin D level may be closely related to the neonatal thyroid TSH level,Suggesting that blood glucose control and vitamin D supplementation during pregnancy are very important.
Objective To explore the correlation between different blood glucose control levels and 25-hydroxyvitamin D levels in GDM pregnant women and their neonatal thyroid TSH levels. Methods Selected 150 cases of pregnant women with gestational diabetes mellitus as observation group,150 healthy pregnant women were selected as control group. Collected clinical data of two groups of pregnant women,the basic information including age and weight. In addition to routine prenatal examination,the thyroid function of two groups was detected( FT_3、FT_4、TSH、TPOAb),the level of Hb A1 c and 25-hydroxyvitamin D. After delivery of the two groups,the newborn's heel blood was taken to detect the thyroid function of the newborn( FT_3、FT_4、TSH). Results When compared with the control group,the glycosylated hemoglobin level in the observation group was significantly higher than that in the control group( P < 0. 05),and the 25-hydroxyvitamin D level in the observation group was significantly lower than that in the control group( P<0. 05). The level of FT_3 and FT_4 in the Newborns of the observation group were lower than that of the control group,and the level of TSH was significantly higher than that of the control group. The level of glycosylated hemoglobin in pregnant women with diabetes is positively correlated with the level of neonatal thyroid TSH. There is a negative correlation between the level of 25-hydroxyvitamin D pregnant women with diabetes mellitus and the level of thyroid TSH in neonates( P<0. 05). Conclusion The poorer blood glucose control in diabetic pregnant women,the lower vitamin D level may be closely related to the neonatal thyroid TSH level,Suggesting that blood glucose control and vitamin D supplementation during pregnancy are very important.
引文
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[20]周瑶瑶.2型糖尿病患者甲状腺功能变化情况及临床特点分析[D].南宁:广西医科大学,2017.
[2]Hunt KJ,Schuller KL.The increasing prevalence of diabetes in pregnancy[J].Obstet Gynecol Clin North Am,2007,34(2):173-199.
[3]Wielgos M,Bomba-Opon D,Czajkowski K,et al.Towards a european consensus on gestational diabetes mellitus:a pragmatic guide for diagnosis,management,and care.The polish diabetes in pregnancy study group and FIGO[J].Ginekol Pol,2017,88(1):46-49.
[4]Barrett H,Mcelduff A.Vitamin D and pregnancy:an old problem revisited[J].Best Pract Res Clin Endocrinol Metab,2010,24(4):527-539.
[5]黄颖,赵立,方芳,等.妊娠期糖尿病对母子的远期影响及产后随访策略[J].上海交通大学学报:医学版,2016,36(9):1373-1377.
[6]Karakosta P,Alegakis D,Georgiou V,et al.Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes[J].J Clin Endocrinol Metab,2012,97(12):4464-4472.
[7]尹伟.妊娠期糖尿病对新生儿甲状腺功能的影响[D].济南:山东大学,2012.
[8]李珍梅,钟义春,陈晓正,等.亚临床甲状腺功能减退合并妊娠期糖尿病孕妇血清维生素D水平的研究[J].现代诊断与治疗,2016,27(14):2657-2658.
[9]Zhang Q,Cheng Y,He M.Effect of various doses of vitamin D supplementation on pregnant women with gestational diabetes mellitus:Arandomized controlled trial[J].Exp Ther Med,2016,12(3):1889-1895.
[10]American Diabetes Association.Standards of medical care in diabetes-2011[J].Diabetes Care,2011,34(S1):S11-S61.
[11]Lu M,Xu Y,Lv L,et al.Association between-vitamin D status and the risk of gestational diabetes mellitus:a meta-analysis[J].Arch Gynecol Obstet,2016,293(5):959-966.
[12]Al-Aissa Z,Hadarits O,Rosta K,et al.A brief of gestational diabetes mellitus,risk factors and current criteria of diagnosis[J].Orv Hetil,2017,158(8):283-290.
[13]安娜,权莉,曹婷,等.血清维生素D与2型糖尿病相关性研究[J].临床合理用药杂志,2012,5(21):3-5.
[14]Akbay E,Tiras MB,Yetkin I,et al.Insulin secretion and insulin sensitivity in normal pregnancy and gestatioal diabetes melitus[J].Gynecol Endocrionol,2003,17(2):137.
[15]黄一颖,应豪.妊娠中期妇女血25-羟维生素D3与妊娠期糖尿病的关系[J].国际妇产科学杂志,2013,40(4):379-381,389.
[16]Zhang Q,Cheng Y,He M,et al.Effect of various doses of vitamin D supplementation on pregnant women with gestational diabetes mellitus:A randomized controlled trial[J].Exp Ther Med,2016,12(3):1889-1895.
[17]王凯航,向菲.血清25-羟维生素D与妊娠期糖尿病相关性分析[J].重庆医学,2015,44(17):2362-2364.
[18]王薇,杨慧霞.维生素D与妊娠期糖尿病[J].中华围产医学杂志,2015,18(2):140-144.
[19]金汉珍,黄德珉,宫希吉主编实用新生儿学第版,北京,人民卫生出版社,2003:245-246.
[20]周瑶瑶.2型糖尿病患者甲状腺功能变化情况及临床特点分析[D].南宁:广西医科大学,2017.