妊娠期亚临床甲状腺功能减退症及TPOAb阳性孕妇治疗与否对妊娠期糖尿病发病率的影响

Effect of subclinical hypothyroidism during pregnancy and treatment acceptance of pregnant women complicated with positive thyroid peroxidase antibody on incidence rate of gestational diabetes mellitus

目的探讨亚临床甲状腺功能减退(SCH)及其甲状腺过氧化物酶抗体(TPOAb)阳性孕妇治疗与否对妊娠期糖尿病(GDM)发病率的影响。方法在经甲状腺功能筛查诊断为SCH的孕妇中,按是否愿意接受左旋甲状腺素(L-T)治疗,选取治疗及不治疗的SCH孕妇各360例为SCH组;甲状腺功能正常孕妇720例为对照组。SCH组中根据TPOAb检测结果分为TPOAb(+)治疗组117例、TPOAb(+)未治疗组131例;TPOAb(-)治疗组243例、TPOAb(-)未治疗组229例。比较SCH组与对照组的TPOAb阳性率情况,TPOAb(+)组与TPOAb(-)组的治疗率,并根据口服糖耐量试验(OGTT)结果比较各组GDM发病率。结果 1SCH组的TPOAb阳性率高于对照组(P<0.01)。TPOAb阳性组治疗率与TPOAb阴性组比较差异无统计学意义(P>0.05)。2SCH组中GDM发病率高于对照组(P<0.05)。SCH治疗组360例中发病率低于SCH未治组360例,差异有统计学意义(P<0.05)。SCH治疗组的发病率与对照组无明显差异(P>0.05),SCH未治组的发病率高于对照组(P<0.01)。3TPOAb(+)组的GDM总体发病率高于对照组(P<0.01),其中TPOAb(+)治疗组发病率与对照组无明显差异(P>0.05),TPOAb(+)未治疗组中发病率明显高于对照组(P<0.01),也高于TPOAb(+)治疗组(P<0.05)。4TPOAb阴性组中,GDM总体发病率高于对照组,但差异无统计学意义(P>0.05);其中TPOAb(-)治疗组发病率与对照组无明显差异(P>0.05),而TPOAb(-)未治疗组发病率高于对照组,差异无统计学意义(P>0.05),且与TPOAb(-)治疗组比较也无明显差异(P>0.05)。结论 SCH会增加孕妇尤其是TPOAb阳性孕妇的GDM发病风险,使用L-T有利于改善SCH特别是TPOAb阳性孕妇的GDM的发病率。

Objective To explore the effect of subclinical hypothyroidism （SCH） during pregnancy and treatment acceptance of pregnant women complicated with positive thyroid peroxidase antibody （TPOAb） on incidence rate of gestational diabetes mellitus （ GDM ） . Methods The pregnant women diagnosed as SCH by thyroid function screening were selected, then they were divided into SCH group （360 pregnant women with SCH） and control group （720 pregnant women with normal thyroid function） . The pregnant women in SCH group were divided into TPOAb （＋） treatment group （117 pregnant women） and TPOAb （＋） non-treatment group （131 pregnant women）, TPOAb （-） treatment group （243 pregnant women） and TPOAb （-） non-treatment group （229 pregnant women） . The positive rates of TPOAb in SCH group and control group were compared, the cure rates in TPOAb （ ＋ ） group and TPOAb （ - ） group were compared, the incidence rates of GDM were compared according to oral glucose tolerance test （OGTT） . Results The positive rate of TPOAb in SCH group was statistically significantly higher than that in control group （P〈0.01 ） . There was no statistically significant difference in the cure rate between positive TPOAb group and negative TPOAb group （ P〉0. 05 ） . The incidence rate of GDM in SCH group was statistically significantly higher than that in control group （ P〈0. 05 ） . There was statistically significant difference in the incidence rate of GDM between SCH treatment group and SCH non-treatment group （P〈0. 05 ） . There was no statistically significant difference in the incidence rate of GDM between SCH treatment group and control group （P〉0. 05 ） . The incidence rate of GDM in SCH non-treatment group was statistically significantly higher than that in control group （P〈0. 01 ） . The total incidence rate of GDM in positive TPOAb group was statistically significantly higher than that in control group （P〈0. 01 ） . There was no statistically significant difference in the incidence rate of GDM between positive TPOAb treatment group and control group （ P〉0.05 ） . The incidence rate of GDM in positive TPOAb non-treatment group was statistically significantly higher than those in control group （P〈0. 01 ） and positive TPOAb treatment group （ P〈0. 05 ） . The total incidence rate of GDM in negative TPOAb group was higher than that in control group, but there was no statistically significant difference （ P〉0. 05 ） . There was no statistically significant difference in the incidence rate of GDM between negative TPOAb treatment group and control group （P〉0. 05 ） . The incidence rate of GDM in negative TPOAb non-treatment group was higher than that in control group, but there was no statistically significant difference （ P〉0. 05） . There was no statistically significant difference in the incidence rate of GDM between negative TPOAb non-treatment group and negative TPOAb treatment group （P〉0. 05） . Conclusion SCH increases the incidence rate of GDM among pregnant women, especially the pregnant women with positive TPOAb. Levothyroeine can improve the incidence rate of GDM in pregnant women with SCH, es-pecially the pregnant women with positive TPOAb.