孕期不同甲状腺功能状态血清高密度脂蛋白胆固醇和载脂蛋白A-Ⅰ的变化趋势

Variation tendency in serum high density lipoprotein cholesterol and apolipoprotein A-Ⅰ in different thyroid function status during pregnancy

目的：研究不同甲状腺功能状态对孕妇血清高密度脂蛋白胆固醇（high density cholesterol,HDL-C）和载脂蛋白A-Ⅰ（apolipoprotein A-Ⅰ,ApoA-Ⅰ）代谢的影响。方法：采集30名甲状腺功能正常（正常组）、19名亚临床甲状腺功能减退（亚甲减组）及8名亚临床甲状腺功能亢进（亚甲亢组）孕妇孕9~12、14~17、23~26和37~40周的空腹血清标本,测其血清HDL-C和ApoA-Ⅰ含量。采用重复测量数据方差分析的秩和检验分析4个妊娠时段孕妇血清HDL-C、ApoA-Ⅰ含量的变化;采用一般线性模型（general linear model,GLM）分析3组孕妇孕期血清HDL-C、ApoA-Ⅰ含量的差异。结果：孕期各组孕妇血清HDL-C含量的变化差异均无统计学意义（χ~2=5.428,P=0.143;χ~2=2.027,P=0.567;χ~2=2.885,P=0.410）,正常孕妇和亚甲减孕妇血清ApoA-Ⅰ的含量增高,差异均有统计学意义（χ~2=46.343,P〈0.001;χ~2=35.984,P〈0.001）,亚甲亢孕妇血清ApoA-Ⅰ含量的变化差异无统计学意义（χ~2=6.750,P=0.080）。亚甲亢孕妇孕期血清HDL-C和ApoA-Ⅰ的含量均低于正常孕妇,差异均有统计学意义（P=0.025,P=0.027）,正常孕妇与亚甲减孕妇孕期血清HDL-C和ApoA-Ⅰ含量的差异均无统计学意义（P=0.378,P=0.549）。结论：妊娠期亚甲亢影响孕妇血清HDL-C和ApoA-Ⅰ代谢,进而影响胎儿的生长发育;妊娠期亚甲减（经优甲乐治疗后）未发现影响孕妇血清HDL-C和ApoA-Ⅰ代谢。

Objective： To study the metabolism of high density lipoprotein cholesterol（ HDL-C） and apolipoprotein A-Ⅰ（ Apo A-Ⅰ） in different thyroid function status during pregnancy. Methods： This study recruited thirty cases of euthyroid,with nineteen cases of subclinical hypothyroid and eight cases of subclinical hyperthyroid pregnancy. The concentrations of fasting serum HDL-C and Apo A-Ⅰwere detected and analyzed from 9-12,14-17,23-26,and 37-40 gestational weeks. Friedman repeated measures ANOVA on ranks was adopted to analyze the changes of serum HDL-C and Apo A-Ⅰat different stages. General linear model（ GLM） was adopted to analyze the differences of serum HDL-C and Apo A-Ⅰin different thyroid function status during pregnancy. Results： There were no significant differences of maternal serum HDL-C among different stages（ χ~2= 5. 428,P = 0. 143,χ~2= 2. 027,P = 0. 567,χ~2= 2. 885,P = 0. 410）. There were significant differences of serum Apo A-Ⅰ during euthyroid and subclinical hypothyroid pregnancies（ χ~2=46. 343,P〈0. 001,χ~2= 35. 984,P〈0. 001）,and no significant difference during subclinical hyperthyroid pregnancy（ χ~2= 6. 750,P = 0. 080）. There were significant differences of serum HDL-C and Apo A-Ⅰbetween euthyroid and subclinical hyperthyroid pregnancies（ P = 0. 025,P = 0. 027）,and no significant differences between euthyroid and subclinical hypothyroid pregnancies（ P = 0. 378,P = 0. 549）. Conclusion： Subclinical hyperthyroidism affected the metabolism of maternal serum HDL-C and Apo A-Ⅰ,which could affect the fetal growth and development. Subclinical hypothyroidism（ after treatment with drugs） had no obvious effect on the metabolism of maternal serum HDL-C and Apo A-Ⅰ.