妊娠期糖尿病在妊娠各期的甲状腺功能及铁蛋白水平分析
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摘要
目的探讨妊娠期糖尿病(GDM)在妊娠各期的甲状腺功能及铁蛋白(SF)水平,旨在减少孕产期并发症和不良结局的发生。方法建立该院正常妊娠期女性的促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)的参考值范围并确定妊娠各期甲状腺功能减退的诊断标准。选取该院2016年3―10月产检门诊行常规产前检查,孕周为6～40周的孕妇343例,其中GDM患者123例作为观察组,健康妊娠女性220例作为对照组,观察2组研究对象妊娠各期的甲状腺功能减退及SF的代谢情况。结果除孕早期临床甲状腺功能减退(临床甲减)、亚临床甲状腺功能减退(亚临床甲减)、孕中期临床甲减的发病率在观察组与对照组差异无统计学意义(P>0.05);其他妊娠各期的临床甲减、亚临床甲减、低T4血症的发病率,观察组均高于对照组,差异有统计学意义(P<0.05),而妊娠各期的SF水平虽随孕周的增大呈下降趋势,但观察组均高于对照组,差异有统计学意义(P<0.05)。结论 GDM患者较高的甲减发病率可加大GDM孕产期并发症的发生,同时GDM时较高的SF又促进了GDM的发生和发展,更增加了孕期的不良结局及新生儿发病的风险。因此了解GDM患者妊娠各期甲状腺功能及SF的代谢情况对甲减的诊断治疗,合理进行铁元素补充,减少孕产期并发症,保障母婴健康具有重要意义。
Objective To understand the gestational diabetes mellitus(GDM)in pregnancy periods of thyroid function and ferritin(SF)level of relevant information,and to provide the basis for the prevention,diagnosis,treatment,so as to reduce the maternal complications and adverse outcomes.Methods Reference range of thyroid-stimulating hormone(TSH)were established,three free iodine thyroid original thyroid hormones(FT3)and free amino acid(FT4)in our hospital and determine the diagnostic criteria of pregnancy periods hypothyroidism.343 cases of pregnant women in 6―40 weeks of gestation weeks were selected in our hospital from Mar.2016 to Oct.2016 as the research objects,including 123 cases of GDM patients as observation group,220 cases of healthy pregnant women as control group.The incidence of pregnancy periods of hypothyroidism and SF,metabolic situation were observed.Results The incidence of the pregnancy early clinical hypothyroidism,subclinical hypothyroidism and mid pregnancy hypothyroidism was no significant difference(P>0.05)in observation group and control group.The incidence of clinical hypothyroidism,subclinical hypothyroidism and low T4 in all other pregnancy stages was higher in the observation group than that in the control group(P<0.05).And although the SF levels of pregnancy periods along with the increase of gestational age was on the decline,but that in the observation group were higher than that in control group,the difference was statistically significant(P<0.05).Conclusion GDM with a high incidence of hypothyroidism can increase the GDM complications.High SF with GDM promote the occurrence and development of GDM,increased the risk of adverse pregnancy outcome.
Objective To understand the gestational diabetes mellitus(GDM)in pregnancy periods of thyroid function and ferritin(SF)level of relevant information,and to provide the basis for the prevention,diagnosis,treatment,so as to reduce the maternal complications and adverse outcomes.Methods Reference range of thyroid-stimulating hormone(TSH)were established,three free iodine thyroid original thyroid hormones(FT3)and free amino acid(FT4)in our hospital and determine the diagnostic criteria of pregnancy periods hypothyroidism.343 cases of pregnant women in 6―40 weeks of gestation weeks were selected in our hospital from Mar.2016 to Oct.2016 as the research objects,including 123 cases of GDM patients as observation group,220 cases of healthy pregnant women as control group.The incidence of pregnancy periods of hypothyroidism and SF,metabolic situation were observed.Results The incidence of the pregnancy early clinical hypothyroidism,subclinical hypothyroidism and mid pregnancy hypothyroidism was no significant difference(P>0.05)in observation group and control group.The incidence of clinical hypothyroidism,subclinical hypothyroidism and low T4 in all other pregnancy stages was higher in the observation group than that in the control group(P<0.05).And although the SF levels of pregnancy periods along with the increase of gestational age was on the decline,but that in the observation group were higher than that in control group,the difference was statistically significant(P<0.05).Conclusion GDM with a high incidence of hypothyroidism can increase the GDM complications.High SF with GDM promote the occurrence and development of GDM,increased the risk of adverse pregnancy outcome.
引文
[1]朱佳尔.妊娠期糖尿病血清铁蛋白变化及其与胰岛素抵抗的相关性研究[J].中国妇幼保健,2013,28(27):4466-4468.
[2]龙燕,时娟娟,张晓璐,等.妊娠20周前甲状腺功能参考范围和甲状腺功能异常患病率[J].中华围产医学杂志,2012,15(12):737-742.
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[4]BALOCH Z,CARAYON P,CONTE-DEVOLX B,et al.Laboratory medicine practice guidelines.Laboratory support for the diagnosis and monitoring of thyroid disease[J].Thyroid,2003,13(1):12 3-126.
[5]STAGNARO-GREEN A,ABALOVICH M,ALEXAN-DER E,et al.Guidelines of the American thyroid association for the diagnosis and management of thyroid disease during pregnancy and postpartum[J].Thyroid,2011,21(10):1081-1125.
[6]中华医学会内分泌学分会,中华医学会围产医学分会.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):354-371.
[7]曾丽娜,陈文玮.妊娠与亚临床甲状腺功能减退症[J].齐齐哈尔医学院学报,2011,32(20):3344-3346.
[8]张宏,白景文,赵伟,等.糖尿病大鼠甲状腺组织的超微病理改变[J].天津医药,2006,34(2):108-110.
[9]曾姝丽,苏放明.亚临床甲状腺功能减退与妊娠期糖尿病的关系[J].实用妇产科杂志,2013,29(1):22-24.
[10]黄艳萍,卢海英,邓璐莎.妊娠中、晚期妇女甲状腺功能变化特点的研究[J/CD].中华临床医师杂志(电子版),2009,3(6):1009-1012.
[11]车素侠,周力,何卫社,等.妊娠期女性甲状腺功能的相关指标分析[J].河北医药,2016,38(19):2999-3001.
[12]史娜娜,马莉,黄亚娟,等.建立特异性甲状腺功能参考值在评价妊娠晚期甲状腺功能减退中的意义[J].中国妇幼保健,2015,30(29):4964-4967.
[13]AMERICAN DIABETES ASSOCIATION.Standards of medical care in diabetes[J].Diabetes Care,2011,34(1):S11-S61.
[14]李迎春,郭遂群,黄敬,等.血清铁蛋白水平与妊娠期糖尿病的相关性研究[J].中国糖尿病杂志,2015,23(4):303-305.
[15]陈灶萍,刘军,查英,等.2型糖尿病血清铁蛋白与胰岛功能的关系[J].实用糖尿病杂志,2008,4(1):19-21.
[16]方少艺.孕晚期血清铁蛋白水平与妊娠期糖尿病的相关性研究[J].中国医学工程,2014,22(11):190.
[2]龙燕,时娟娟,张晓璐,等.妊娠20周前甲状腺功能参考范围和甲状腺功能异常患病率[J].中华围产医学杂志,2012,15(12):737-742.
[3]张翠军,陈新.妊娠期糖尿病铁蛋白的相关研究[J/CD].临床医药文献电子杂志,2015,2(33):6787-6790.
[4]BALOCH Z,CARAYON P,CONTE-DEVOLX B,et al.Laboratory medicine practice guidelines.Laboratory support for the diagnosis and monitoring of thyroid disease[J].Thyroid,2003,13(1):12 3-126.
[5]STAGNARO-GREEN A,ABALOVICH M,ALEXAN-DER E,et al.Guidelines of the American thyroid association for the diagnosis and management of thyroid disease during pregnancy and postpartum[J].Thyroid,2011,21(10):1081-1125.
[6]中华医学会内分泌学分会,中华医学会围产医学分会.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):354-371.
[7]曾丽娜,陈文玮.妊娠与亚临床甲状腺功能减退症[J].齐齐哈尔医学院学报,2011,32(20):3344-3346.
[8]张宏,白景文,赵伟,等.糖尿病大鼠甲状腺组织的超微病理改变[J].天津医药,2006,34(2):108-110.
[9]曾姝丽,苏放明.亚临床甲状腺功能减退与妊娠期糖尿病的关系[J].实用妇产科杂志,2013,29(1):22-24.
[10]黄艳萍,卢海英,邓璐莎.妊娠中、晚期妇女甲状腺功能变化特点的研究[J/CD].中华临床医师杂志(电子版),2009,3(6):1009-1012.
[11]车素侠,周力,何卫社,等.妊娠期女性甲状腺功能的相关指标分析[J].河北医药,2016,38(19):2999-3001.
[12]史娜娜,马莉,黄亚娟,等.建立特异性甲状腺功能参考值在评价妊娠晚期甲状腺功能减退中的意义[J].中国妇幼保健,2015,30(29):4964-4967.
[13]AMERICAN DIABETES ASSOCIATION.Standards of medical care in diabetes[J].Diabetes Care,2011,34(1):S11-S61.
[14]李迎春,郭遂群,黄敬,等.血清铁蛋白水平与妊娠期糖尿病的相关性研究[J].中国糖尿病杂志,2015,23(4):303-305.
[15]陈灶萍,刘军,查英,等.2型糖尿病血清铁蛋白与胰岛功能的关系[J].实用糖尿病杂志,2008,4(1):19-21.
[16]方少艺.孕晚期血清铁蛋白水平与妊娠期糖尿病的相关性研究[J].中国医学工程,2014,22(11):190.