妊娠晚期亚临床甲状腺功能减退孕妇脂代谢水平及其与妊娠期代谢综合征的关系

Lipid metabolism of pregnant women with subclinical hypothyroidism in third trimester of pregnancy and its relationship of with gestational metabolic syndrome

目的研究妊娠晚期亚临床甲状腺功能减退(SCH)孕妇血脂、脂蛋白代谢水平及其与妊娠期代谢综合征(GMS)的关系。方法依据血清甲状腺激素检测结果,选择妊娠晚期SCH孕妇334例(SCH组)和甲状腺功能正常孕妇670例(对照组),检测血清TC、TG、HDL-C、LDL-C、载脂蛋白A(ApoA)、载脂蛋白B(ApoB)、脂蛋白a(LPa)和游离脂肪酸(FFA),分析甲状腺激素水平与脂代谢相关指标的相关性。结果 SCH组血清TC、LDL-C和FFA水平高于对照组(P<0.05),SCH组高血压、肥胖发病率高于对照组(P<0.05),两组GMS发病率无统计学差异(P>0.05)。SCH组患者的TSH与舒张压、TC、LDL-C和FFA呈正相关(P<0.05或P<0.01),FT3/FT4与BMI、收缩压和ApoA/ApoB呈正相关(P<0.01),与TC、HDL-C、LDL-C和FFA呈负相关(P<0.01)。SCH组中,甲状腺过氧化物酶抗体(TPOAb)阳性患者的HDL-C水平低于TPOAb阴性者,LPa水平高于TPOAb阴性者(P<0.05)。结论妊娠晚期SCH患者存在血脂异常,TC、LDL-C、FFA水平升高,高血压、肥胖发病率上升。TPOAb阳性SCH患者的HDL-C水平下降,LPa水平升高。

Objective To investigate the lipid metabolism of pregnant women with subclinical hypothyroidism（SCH）in third trimester of pregnancy and its relationship of with gestational metabolic syndrome（GMS）.Methods On the basis of thyroid hormone determination,serum levels of total cholesterol（TC）,triglyceride（TG）,high-density lipoprotein cholesterol（HDL-C）,low density lipoprotein cholesterol（LDL-C）,apolipoprotein A（ApoA）,apolipoprotein B（ApoB）,lipoprotein a（LPa）and free fatty acid（FFA）were detected in 334 pregnant women with SCH in third trimester of pregnancy（group A）and 670 pregnant women with normal thyroid function（group B）.The relationship of thyroid hormone levels and lipid GMS-related indicators in group A was analyzed.Results Serum levels of TC,LDL-C and FFA in group A were higher than those in group B（P〈0.05）.The incidence rates of pregnancy-induced hypertension and obesity were higher in group A than those in group B（P〈0.05）.There was no correlation between SCH and GMS（P〉0.05）.Serum TSH level was positively correlated to diastolic blood pressure and serum levels of TC,LDL-C and FFA（P〈0.05 or P〈0.01）.The ratio of FT3 to FT4 was positively correlated to BMI,systolic blood pressure and ApoA/ApoB（P〈0.01）,negatively correlated to TC,HDL-C,LDL-C and FFA（P〈0.01）.Serum HDL-C level was lower and LPa was higher in the patients with TPOAb positive than those with TPOAb negative（P〈0.05）.Conclusion The dyslipidemia exists in SCH patients during later trimester of pregnancy,who have an increased serum levels of TC,LDL-C and FFA,higher incidence rate of pregnancy-induced hypertension and obesity.SCH pregnant women with TPOAb positive have lower level of HDL-C and higher level of LPa than those with TPOAb negative.