妊娠中期甲状腺功能状态与妊娠糖尿病的关系

Correlation between thyroid function and gestational diabetes mellitus in second trimester of pregnancy

目的 了解妊娠期血糖水平与促甲状腺素（TSH）之间是否具有相关性,并评估妊娠期间甲状腺激素及甲状腺自身抗体的水平在筛查妊娠糖尿病（GDM）中的作用。方法 随机选取在重庆医科大学附属第一医院产检的孕14~28周妇女265名,测定血清TSH、游离三碘甲腺原氨酸（FT3）、游离甲状腺素（FT4）、甲状腺过氧化物酶抗体（TpoAb）水平,并于孕28周行75 g OGTT检查,统计GDM的发病率,GDM发病率与TpoAb水平之间的相关性、TSH与OGTT各时间点血糖水平的相关性分析采用Spearman秩相关分析。结果 1妊娠中期GDM发病率为19.2%,总的甲状腺功能异常发病率为3.8%,TpoAb阳性率为6.8%。2妊娠中期GDM的发病与TSH值之间没有相关性。3妊娠中期GDM的发病与TpoAb是否阳性没有相关性（P=0.774）。4GDM者的甲状腺功能和自身抗体与非GDM者无显著差别。结论 尚无明确证据支持妊娠甲状腺疾病与GDM之间存在相互性,临床工作中应对两种疾病单独筛查,避免漏诊。

Objective To investigate the correlation between blood glucose and thyroid-stimulating hormone （TSH） during gestation and evaluate the role of thyroid hormones and thyroid autoantibodies levels during gestation in screening gestational diabetes mellitus （GDM）. Methods A total of 265 women with 14 -28 weeks of pregnancy who were examined at the First Affdiated Hospital of Chongqing Medical University were randomly selected. Levels of serum TSH, free triiodothyronine （ FT3 ）, free thyroxine （ FT4 ）, and thyroid peroxidase antibodies （TpoAb） were detected. The 75 g OGTT examination was performed in 28th week of pregnancy. The incidence of GDM was recorded. Spearman rank correlation analysis was adopted to analyze the correlation between the incidence of GDM and TpoAb level and between TSH and blood glucose level at each time point of OGTT. Results （1）The incidence of GDM in second trimester of pregnancy was 19.2%, the overall incidence of abnormal thyroid function was 3.8O/o, and the positive rate of TpoAb was 6.8% （2）The incidence of GDM in second trimester of pregnancy did not correlate with TSH. （3）The incidence of GDM in second trimester of pregnancy did not correlate with whether TpoAb was positive （P = 0. 774）. （4） The differences of thyroid function and autoantibodies between women with GDM and without GDM were not significant. Conclusion There is no obvious evidence that supports the correlation between thyroid disease and GDM. Two diseases should be screened separately to avoid misdiagnosis.