左甲状腺素治疗TPOAb阴性妊娠期亚甲减与妊娠期糖尿病的相关性研究

Effect of L-thyroxine on Subclinical Hypothyroidism During Pregnancy with Negative TPOAb on Gestational Diabetes Mellitus

目的 探讨TPOAb阴性妊娠期亚甲减孕妇左甲状腺素治疗与妊娠期糖尿病(GDM)的相关性.方法 选择2018年1月—2019年10月在苏州大学附属第二医院分娩的6734例孕妇,其中TPOAb阴性妊娠期亚甲减孕妇304例,根据是否接受左甲状腺素治疗分为亚甲减治疗组180例和亚甲减未治疗组124例,随机选择同期300名正常孕妇为对照组.对三组间GDM发生率、甲状腺功能指标与OGTT各值及GDM发生的相关性进行分析.结果 亚甲减治疗组和亚甲减未治疗组的GDM发病率与对照组比较,差异有统计学意义(P<0.05).甲状腺功能与GDM发病的Logistic回归:FT4与GDM的发生呈负相关(OR=1.211,95%CI:1.029~1.425),TSH与GDM的发病呈正相关(OR=0.807,95%CI:0.807~0.989),差异均有统计学意义(P<0.05).结论 1.甲状腺功能与血糖代谢异常有相关性.2.左旋甲状腺素可降低TPOAb阴性妊娠早期亚甲减孕妇GDM的发生率.3.FT4是GDM发生的保护因素.

Objective To investigate the effect of the L-thyroxine on subclinical hypothyroidism(SCH)during pregnancy with negative TPOAb on the gestational diabetes mellitus(GDM).Methods 6734 pregnant women who were hospitalized for delivery were selected in the Second Affiliated Hospital of Soochow University from January 2018 to October 2019.304 pregnant women had negative TPOAb.They were divided into the SCH treated group(n=180)and the SCH untreated group(n=124)according to the L-T4 alternative treatment.The control group:300 pregnant women with normal thyroid function.The incidence of GDM among the three groups was analyzed and the correlation of the thyroid function indicators,OGTT values and GDM occurrence were analyzed.Results Compared with the control group,the incidence of GDM in the SCH treated group and SCH untreated group was statistically different(P<0.05).The Logistic regression of thyroid function and the incidence of GDM:FT4 was negatively correlated with the incidence of GDM(OR=1.211,95%CI:1.029-1.425)and TSH was positively correlated with the incidence of GDM(OR=0.807,95%CI:0.807-0.989),all these relationships had statistical significance(P<0.05).Conclusion 1.Thyroid function is correlated with abnormal glucose metabolism.2.The use of the L-thyroxine can reduce the incidence of GDM in the SCH during pregnancy with negative TPOAb.3.FT4 is a protective factor for GDM。