亚临床甲状腺功能减退对妊娠期糖尿病患者白细胞介素-6、超敏C-反应蛋白、血糖及胰岛功能的影响

Effect of subclinical hypothyroidism on serum IL-6,hs-CRP and blood glucose and pancreatic function in gestational diabetes mellitus patient

目的探讨亚临床甲状腺功能减退(SCH)对妊娠期糖尿病(GDM)患者白细胞介素-6 (IL-6)、超敏C-反应蛋白(hs-CRP)、血糖及胰岛功能的影响,为临床诊断与治疗提供相应的数据支持。方法选择2016年3月-2017年3月在天津市西青区妇女儿童保健中心就诊的SCH合并GDM孕妇103例作为研究对象,根据促甲状腺素(TSH)水平,将患者分成A组(轻度SCH者,TSH水平为2. 50～4. 22 m U/L) 65例和B组(重度SCH者,TSH水平>4. 22 m U/L) 38例。另选同期在天津市西青区妇女儿童保健中心就诊的甲状腺功能处于正常状态的GDM孕妇50例记为对照组。检测并对比各组IL-6、hs-CRP、甲状腺过氧化物酶抗体(TPOAb)及TSH水平,各组血糖和胰岛功能指标(包括空腹血糖FBG、糖化血红蛋白Hb A1c、胰岛素FINS及胰岛素抵抗指数HOMA-IR),利用Spearman法分析SCH合并GDM患者各指标间的相关性。结果 A、B两组的IL-6、hs-CRP、TPOAb及TSH水平均分别明显高于对照组,且B组的IL-6、hs-CRP及TSH水平均分别明显高于A组,差异有统计学意义(均P<0. 05)。各组的FBG、Hb A1c及FINS水平相比,差异无统计学意义(均P>0. 05)。A、B两组的HOMA-IR水平分别明显高于对照组,且B组高于A组,差异有统计学意义(均P<0. 05)。SCH合并GDM孕妇的HOMA-IR与IL-6、hs-CRP及TSH均呈正相关,且TSH与IL-6及hs-CRP也呈正相关。结论 SCH合并GDM患者IL-6、hs-CRP可明显升高,临床上可通过监测SCH合并GDM患者IL-6、hs-CRP、HOMA-IR等指标更好地帮助临床诊断及治疗。

Objective To study the effects of subclinical hypothyroidism （SCH） on serum IL-6, hs-CRP and blood glucose and pan- creatic function in gestational diabetes mellitus （GDM） patient Methods From March 2016 to March 2017, 103 pregnant women with SCH combined with GDM in the hospital were selected as the subjects, according to the level of thyroid stimulating hormone （ TSH）, the patients were divided into group A （ mild subclinical hypothyroidism, TSH level from 2. 50 to 4. 22mIU/L） in 65 cases, and group B （ se- vere subclinical hypothyroidism, TSH level greater than or equal to 4. 22mIU/L） in 38 cases. Another 50 GDM pregnant women with normal thyroid function in the hospital at the same time were enrolled as control group. The levels of interleukin -6 （IL-6）, hypersensitivity C re- active protein （hs-CRP）, thyroid peroxidase antibody （TPOAb） and TSH were detected and compared, blood glucose and pancreatic function indexes （including fasting blood glucose, FBG, glycosylated hemoglobin, HbA1 c, insulin, FINS and insulin resistance index, IRI） in each group were compared, spearman method was used to analyze the correlation between the indexes of patients with SCH and GDM. Results The levels of IL-6, hs-CRP, TPOAb and TSH in group A and B were significantly higher than those in the control group, the levels of IL-6, hs-CRP and TSH in the B group were significantly higher than those in the A group and the differences were statistically significant （P〈0.05） . There were no statistically significant differences in the levels of FBG, HbAlc and FINS between groups （P〉 0. 05 ）. The average IRI level of A and B groups were significantly higher than that of the control group and the B group was higher than that of the A group, the difference was statistically significant （P〈0. 05 ） . HOMA-IR, IL-6, hs-CRP were was positively correlated with TSH in GDM combined with SCH. Conclusion IL-6 and hs-CRP are closely related to the pathogenesis of GDM associated with SCH and SCH and GDM also have close ties, monitoring IL-6, hs-CRP, IRI and other indicators are better to help clinical diagnosis and treatment.