妊娠期糖尿病合并亚临床甲状腺功能减退患者炎性应激状态及凝血功能对妊娠结局的影响
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摘要
目的:探讨妊娠期糖尿病(GDM)合并亚临床甲状腺功能减退(SCH)患者炎症因子及凝血功能变化,及其对妊娠结局的影响。方法:本研究纳入2016年10月—2017年12月陕西省汉中市中心医院产科收治的60例GDM合并SCH患者(合并组)、55例单纯GDM患者(单纯组)及60例健康孕妇(对照组)。比较3组的炎症因子水平、凝血功能及妊娠结局。结果:与对照组比较,单纯组和合并组的肿瘤坏死因子α(TNF-α)、超敏C反应蛋白(hs-CRP)及纤维蛋白原(FIB)水平均显著升高,且合并组水平高于单纯组,差异有统计学意义(P<0.05)。3组活化部分凝血活酶时间(APTT)及凝血酶原时间(PT)比较,差异无统计学意义(P>0.05)。3组胎儿生长受限(FGR)发生率差异有统计学意义(P<0.05),单纯组及合并组高于对照组,合并组高于单纯组。3组剖宫产率差异有统计学意义(P<0.05),合并组高于对照组及单纯组(P<0.05),单纯组与对照组差异无统计学意义(P>0.05)。3组早产及胎盘早剥发生率差异无统计学意义(P>0.05)。结论:GDM合并SCH可造成FIB水平异常,显著升高机体炎性应激反应,并能增加FGR及剖宫产等不良结局发生风险,临床中应加强监测。
Objective:To investigate the inflammatory factors and coagulation function in patients with gestational diabetes mellitus(GDM) and subclinical hypothyroidism(SCH), and the effects on the pregnancy outcome. Methods:Sixty GDM patients with SCH(the combined group), 55 GDM patients(the simple group) and 60 healthy pregnant women(the control group) were selected. The inflammatory factors, coagulation function and pregnancy outcome in the three groups were compared. Results:Compared with the control group, the level of tumor necrosis factor-α(TNF-α), hypersensitive C-reactive protein(hs-CRP) and fibrinogen(FIB) in the simple group and the combined group were increased significantly(P <0.05). The above parameters in the combined group were significantly higher than those in the simple group(P<0.05). There were no significant differences in the levels of activated partial thromboplastin time(APTT) and prothrombin time(PT) among the three groups(P>0.05). The rate of fetal growth restriction in the simple group and the combined group was significantly higher than that in the control group. The rate of cesarean section in the combined group was significantly higher than that in the control group or the simple group(P<0.05). There were no significant differences in the incidences of preterm birth and placental abruption in the three groups(P>0.05). Conclusions:GDM combined with SCH can cause abnormal FIB level, which significantly increases the inflammatory stress and the risk of adverse effects such as fetal growth restriction and cesarean section. Monitoring the inflammatory stress and coagulation function in those patients with GDM and SCH should be strengthened in clinical practice.
Objective:To investigate the inflammatory factors and coagulation function in patients with gestational diabetes mellitus(GDM) and subclinical hypothyroidism(SCH), and the effects on the pregnancy outcome. Methods:Sixty GDM patients with SCH(the combined group), 55 GDM patients(the simple group) and 60 healthy pregnant women(the control group) were selected. The inflammatory factors, coagulation function and pregnancy outcome in the three groups were compared. Results:Compared with the control group, the level of tumor necrosis factor-α(TNF-α), hypersensitive C-reactive protein(hs-CRP) and fibrinogen(FIB) in the simple group and the combined group were increased significantly(P <0.05). The above parameters in the combined group were significantly higher than those in the simple group(P<0.05). There were no significant differences in the levels of activated partial thromboplastin time(APTT) and prothrombin time(PT) among the three groups(P>0.05). The rate of fetal growth restriction in the simple group and the combined group was significantly higher than that in the control group. The rate of cesarean section in the combined group was significantly higher than that in the control group or the simple group(P<0.05). There were no significant differences in the incidences of preterm birth and placental abruption in the three groups(P>0.05). Conclusions:GDM combined with SCH can cause abnormal FIB level, which significantly increases the inflammatory stress and the risk of adverse effects such as fetal growth restriction and cesarean section. Monitoring the inflammatory stress and coagulation function in those patients with GDM and SCH should be strengthened in clinical practice.
引文
[1]李科珍,杨奕梅,孙宇,等.妊娠期糖尿病孕妇甲状腺功能变化分析[J].云南医药,2016,37(4):434-436.
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[3]孙翀.妊娠合并甲状腺功能减退症和亚临床甲状腺功能减退症对妊娠结局的影响[J].中国妇幼保健,2013,28(35):5810-5812.
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[5]李春莉,黄卉,李秋红.妊娠早期亚临床甲状腺功能减退与妊娠糖尿病的相关性研究[J].中华内分泌代谢杂志,2014,30(9):747-748.
[6]侯扬.2型糖尿病合并亚临床甲状腺功能减退患者炎症因子水平测定及意义[D].太原:山西医科大学,2015.
[7]乔国昱,何亚萍,周洁.妊娠期糖尿病并发甲状腺功能减退孕妇凝血功能指标的变化研究[J].现代检验医学杂志,2017,32(3):109-111.
[8]何亚萍,乔国昱,靳颖,等.亚临床甲状腺功能减退症合并妊娠期糖尿病孕妇的生物学指标检测及意义[J].中国妇幼保健,2015,30(19):3158-3160.
[9]中华医学会内分泌学分会.妊娠和产后甲状腺疾病诊治指南[J].中华内分泌代谢杂志,2012,28(5):354-367.
[10]中华医学会妇产科分会产科学组.妊娠合并糖尿病临床诊断与治疗推荐指南(草案)[J].中华围产医学杂志,2007,10(4):283-285.
[11]Mansouri A,Norouzi S,Sharifi A,et al.The Relationship of Maternal Subclinical Hypothyroidism during Pregnancy and Preterm Birth:A Systematic Review and Meta-Analysis of Cohort Studies[J].Iran J Obstet Gynecol Infertil,2017,19(40):69-78.
[12]周兰芳,夏婷.妊娠期甲状腺功能减退和妊娠期糖尿病的相关性研究[J].中国妇幼保健,2016,31(9):1822-1824.
[13]李珍梅,钟义春,陈晓正,等.2型糖尿病合并亚临床甲状腺功能减退症与糖尿病微血管并发症的相关性分析[J].现代诊断与治疗,2016,27(13):2370-2372.
[14]高娟,苏恒.糖尿病合并亚临床甲状腺功能减退症的研究进展[J].检验医学与临床,2014,11(3):405-406.
[15]滕振娟,曲昌华,杨丽娟.亚临床甲状腺功能减退症合并妊娠期糖尿病对患者生化指标及妊娠结局的影响[J].国际医药卫生导报,2017,23(7):993-996.
[16]Banks PA,Bollen TL,Dervenis C,et al.Classification of acute pancreatitis--2012:revision of the Atlanta classification and definitions by international consensus[J].Gut,2013,62(1):102-111.
[17]李小丽,何一飞,刘云峰,等.甲状腺功能正常及亚临床甲状腺功能减退人群中TGAb TPOAb与hs-CRP TNF-α颈动脉内膜中层厚度的关系[J].中国药物与临床,2016,16(6):844-847.
[18]彭晶.SOD、NO、TNF-α和hs-CRP对高血压合并糖尿病患者动脉粥样硬化的影响[J].国际检验医学杂志,2016,37(23):3285-3287.
[19]Akram Kooshki A,Tofighiyan T,Rakhshani MH.Effects of Synbiotics on Inflammatory Markers in Patients With Type 2Diabetes Mellitus[J].Glob J Health Sci,2015,7(7):1-5.
[20]Haidari F,Jalali MT,Shahbazian N,et al.Comparison of Serum Levels of Vitamin D and Inflammatory Markers Between Women With Gestational Diabetes Mellitus and Healthy Pregnant Control[J].J Family Reprod Health,2016,10(1):1-8.
[21]张惠萍.妊娠期糖尿病患者细胞免疫功能及hs-CRP、IL-6、TNF-α水平的研究[J].中国妇幼保健,2016,31(6):1189-1190.
[22]Yazdchi R,Gargari BP,Asghari-Jafarabadi M,et al.Effects of vitamin D supplementation on metabolic indices and hs-CRPlevels in gestational diabetes mellitus patients:a randomized,double-blinded,placebo-controlled clinical trial[J].Nutr Res Pract,2016,10(3):328-335.
[2]康苏娅,汪云,伍理.亚临床甲状腺功能减退对妊娠期糖尿病发病及其妊娠结局的影响[J].国际妇产科学杂志,2014,41(4):419-422.
[3]孙翀.妊娠合并甲状腺功能减退症和亚临床甲状腺功能减退症对妊娠结局的影响[J].中国妇幼保健,2013,28(35):5810-5812.
[4]吕志辉,周巧莲,杨卓加.妊娠期糖尿病合并亚临床甲状腺功能减退对妊娠结局的影响[J].中国综合临床,2015,31(7):653-655.
[5]李春莉,黄卉,李秋红.妊娠早期亚临床甲状腺功能减退与妊娠糖尿病的相关性研究[J].中华内分泌代谢杂志,2014,30(9):747-748.
[6]侯扬.2型糖尿病合并亚临床甲状腺功能减退患者炎症因子水平测定及意义[D].太原:山西医科大学,2015.
[7]乔国昱,何亚萍,周洁.妊娠期糖尿病并发甲状腺功能减退孕妇凝血功能指标的变化研究[J].现代检验医学杂志,2017,32(3):109-111.
[8]何亚萍,乔国昱,靳颖,等.亚临床甲状腺功能减退症合并妊娠期糖尿病孕妇的生物学指标检测及意义[J].中国妇幼保健,2015,30(19):3158-3160.
[9]中华医学会内分泌学分会.妊娠和产后甲状腺疾病诊治指南[J].中华内分泌代谢杂志,2012,28(5):354-367.
[10]中华医学会妇产科分会产科学组.妊娠合并糖尿病临床诊断与治疗推荐指南(草案)[J].中华围产医学杂志,2007,10(4):283-285.
[11]Mansouri A,Norouzi S,Sharifi A,et al.The Relationship of Maternal Subclinical Hypothyroidism during Pregnancy and Preterm Birth:A Systematic Review and Meta-Analysis of Cohort Studies[J].Iran J Obstet Gynecol Infertil,2017,19(40):69-78.
[12]周兰芳,夏婷.妊娠期甲状腺功能减退和妊娠期糖尿病的相关性研究[J].中国妇幼保健,2016,31(9):1822-1824.
[13]李珍梅,钟义春,陈晓正,等.2型糖尿病合并亚临床甲状腺功能减退症与糖尿病微血管并发症的相关性分析[J].现代诊断与治疗,2016,27(13):2370-2372.
[14]高娟,苏恒.糖尿病合并亚临床甲状腺功能减退症的研究进展[J].检验医学与临床,2014,11(3):405-406.
[15]滕振娟,曲昌华,杨丽娟.亚临床甲状腺功能减退症合并妊娠期糖尿病对患者生化指标及妊娠结局的影响[J].国际医药卫生导报,2017,23(7):993-996.
[16]Banks PA,Bollen TL,Dervenis C,et al.Classification of acute pancreatitis--2012:revision of the Atlanta classification and definitions by international consensus[J].Gut,2013,62(1):102-111.
[17]李小丽,何一飞,刘云峰,等.甲状腺功能正常及亚临床甲状腺功能减退人群中TGAb TPOAb与hs-CRP TNF-α颈动脉内膜中层厚度的关系[J].中国药物与临床,2016,16(6):844-847.
[18]彭晶.SOD、NO、TNF-α和hs-CRP对高血压合并糖尿病患者动脉粥样硬化的影响[J].国际检验医学杂志,2016,37(23):3285-3287.
[19]Akram Kooshki A,Tofighiyan T,Rakhshani MH.Effects of Synbiotics on Inflammatory Markers in Patients With Type 2Diabetes Mellitus[J].Glob J Health Sci,2015,7(7):1-5.
[20]Haidari F,Jalali MT,Shahbazian N,et al.Comparison of Serum Levels of Vitamin D and Inflammatory Markers Between Women With Gestational Diabetes Mellitus and Healthy Pregnant Control[J].J Family Reprod Health,2016,10(1):1-8.
[21]张惠萍.妊娠期糖尿病患者细胞免疫功能及hs-CRP、IL-6、TNF-α水平的研究[J].中国妇幼保健,2016,31(6):1189-1190.
[22]Yazdchi R,Gargari BP,Asghari-Jafarabadi M,et al.Effects of vitamin D supplementation on metabolic indices and hs-CRPlevels in gestational diabetes mellitus patients:a randomized,double-blinded,placebo-controlled clinical trial[J].Nutr Res Pract,2016,10(3):328-335.