妊娠期糖尿病患者血糖水平对新生儿甲状腺功能和血脂的影响

Effects of glycemic level in pregnant women with gestational diabetes mellitus on newborn thyroid function and blood lipids

目的探讨妊娠期糖尿病(GDM)孕妇不同血糖水平对新生儿甲状腺功能和血脂的影响。方法选择2012年1月—2018年1月在宾阳县人民医院新生儿科行甲状腺功能检查和血脂测定的295例足月新生儿作为研究对象。将血糖控制不理想的GDM孕妇分娩的95例足月新生儿归为GDM未控制组;将血糖控制理想的GDM孕妇分娩的100例足月新生儿归为GDM控制组;同期住院的健康孕妇分娩的100例足月新生儿作为正常组。采用全自动化学发光免疫分析仪检测3组新生儿的甲状腺功能[甲状腺素(T4)、三碘甲状腺原氨酸(T3)、促甲状腺激素(TSH)、游离T4(FT4)、游离T3(FT3)];采用全自动生化分析仪检测3组新生儿的血脂四项[三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]。比较3组新生儿各项检测指标和先天性甲状腺功能低下(CH)的发生率。结果与正常组和GDM控制组比较,GDM未控制组的甲状腺功能指标T3、T4、FT3、FT4均明显降低[T3(nmol/L):0.72±0.32比1.65±0.51、1.49±0.56,T4(nmol/L):63.52±22.50比115.26±23.47、109.76±22.23,FT3(pmol/L):1.42±0.74比3.28±0.57、2.89±0.65,FT4(pmol/L):7.82±2.11比16.11±3.13、14.98±2.68],TSH明显升高(mU/L:12.86±2.12比4.89±1.01、5.15±1.32,均P<0.05);血脂指标TC、TG、LDL-C均明显升高[TC(mmol/L):2.79±0.47比1.62±0.31、1.71±0.34,TG(mmol/L):0.55±0.21比0.21±0.11、0.25±0.13,LDL-C(mmol/L):1.45±0.38比0.78±0.19、0.81±0.22],HDL-C明显降低(mmol/L:0.38±0.21比0.55±0.16、0.57±0.17,均P<0.05);CH发生率均明显升高(2.1%比0%、0%,均P<0.05)。而正常组与GDM控制组的甲状腺功能和血脂水平比较差异均无统计学意义(均P>0.05)。结论 GDM孕妇孕期若血糖控制不理想,可影响新生儿的甲状腺功能和血脂水平;孕期若血糖控制理想,则其新生儿的甲状腺功能和血脂水平与正常新生儿无明显差异。

Objective To investigate the effect of different blood glucose levels in pregnant women with gestational diabetes mellitus（GDM） on thyroid functions and blood lipids in neonates. Methods From January 2012 to January 2018, 295 full-term neonates who underwent thyroid function tests and blood lipid measurements in the Department of Neonatology of Binyang People＇s Hospital were selected as subjects. Ninety-five full-term neonates delivered by GDM pregnant women with unsatisfactory blood glucose control were taken as an observation group; 100 full-term neonates delivered by GDM pregnant women with ideal blood glucose control as a control group, and 100 full-term neonates delivered by healthy pregnant women in the same period in this hospital as a normal group. The thyroid functions [including thyroxine（T4）, triiodothyronine（T3）, thyroid stimulating hormone（TSH）, free T4（FT4） and free T3（FT3）] were detected by automatic chemiluminescent immunoassay（CLIA）; four blood lipids [triacylglycerol（TG）, total cholesterol（TC）, low density lipoprotein cholesterol（LDL-C）, high density lipoprotein cholesterol（HDL-C）] were detected by automatic biochemical analyzer in the 3 groups. The above index results with the normal and control groups, in the observation group, the thyroid function indexes T3, T4, FT3 and FT4 were significantly decreased [T3（nmol/L）： 0.72±0.32 vs. 1.65±0.51, 1.49±0.56, T4（nmol/L）： 63.52±22.50 vs. 115.26±23.47, 109.76±22.23, FT3（pmol/L）： 1.42±0.74 vs. 3.28±0.57, 2.89±0.65, FT4（pmol/L）： 7.82±2.11 vs. 16.11±3.13, 14.98±2.68], while TSH was obviously increased（mU/L： 12.86±2.12 vs. 4.89±1.01, 5.15±1.32, all P〈0.05）; lipid indexes TC, TG, LDL-C were significantly increased [TC（mmol/L）： 2.79±0.47 vs. 1.62±0.31, 1.71±0.34, TG（mmol/L）： 0.55±0.21 vs. 0.21±0.11, 0.25±0.13, LDL-C（mmol/L）： 1.45±0.38 vs. 0.78±0.19, 0.81±0.22], and HDL-C was decreased markedly（mmol/L： 0.38±0.21 vs. 0.55±0.16, 0.57±0.17, all P〈0.05）; the incidence of CH was increased remarkably（2.1% vs. 0%, 0%, all P〈0.05）. There were no significant differences in thyroid functions and serum lipid levels between normal group and control group（all P〉0.05）. Conclusion GDM pregnant women can affect the thyroid function and blood lipid levels of neonates if blood glucose control is not good enough during pregnancy; when blood glucose control is ideal during pregnancy, the thyroid function and blood lipid levels of neonates are not significantly different from those of normal neonates.