孕早期游离甲状腺素与妊娠期糖尿病的相关性研究

Association analysis between free thyroxin during early pregnancy and gestational diabetes mellitus

目的 探讨孕早期游离甲状腺激素(FT4)、游离三碘甲状腺原氨酸(FT3)与GDM的相关性.方法 选取2015年1~8月于我院规律产检、孕前未确诊甲状腺疾病及孕期未使用甲状腺相关药物的孕妇640名,收集常规孕检资料、孕早期甲功三项、妊娠24~28周75 g OGTT检测结果.根据OGTT结果分为GDM组(GDM)90例和血糖正常妊娠组(NGT)550名.比较两组间生化指标,Logistic回归分析GDM发生的影响因素.通过绘制受试者工作特征曲线(ROC)确定FT3/FT4比值预测GDM的最佳临界点.结果 (1)与NGT组比较,GDM组年龄更大,孕前BMI更高,孕早期FPG更高,但孕期体重增加较少[(32±5)vs(29±3)岁,(23.15±3.11)vs(21.41±2.70)kg/m2,(4.90±0.38)vs(4.67±0.33)mmol/L,(13.14±4.61)vs(14.94±4.78)kg,P<0.01],孕早期FT4更低[1.23(1.13,1.30)vs 1.29(1.19,1.38)pg/ml,P<0.01]、FT3更高[3.30(3.04,3.52)vs 3.17(2.97,3.41)pg/ml,P<0.05];(2)Logistic回归分析显示,孕早期FT4、FT3/FT4是GDM发生的影响因素(OR 0.028,95%CI 0.003~0.312),(OR 5.014,95%CI 1.818~13.826),;(3)以FT3/FT4指标做GDM预测的ROC曲线,以FT3/FT42.5519作为切点时,预测GDM的敏感性为70.0%,特异性为60.5%.结论 随着年龄增大,孕前BMI增高,孕早期FPG升高,孕期发生GDM的风险逐渐增加,随着孕早期FT4下降、FT3/FT4比值升高,GDM发生的风险逐渐增加.孕早期FT3/FT4比值大于2.5519时,发生GDM的风险显著增加.

Objective To explore the relationship between free thyroxine (FT4), free triodothyronine (FT3) in early pregnancy and gestational diabetes mellitus (GDM).Methods A retrospective study was con ducted in our hospital from January 2015 to August 2015.A total of 640 patients without thyroid diseases before pregnancy and did no] receive thyroid related drugs treatment during pregnancy were included in this study.Data of routine pregnancy examination, thyroid hormone(TSH, FT3, FT4) in early pregnancy and results of 75 g OGTT at 24-28 weeks were collected.All the subjects were divided into two groups according to OGTT results: gestational diabetes group (GDM) and non-gestational diabetes group (NGT).The clinical characteristics were compared between the two groups.The correlation between FT3, FT4 and GDM was evaluated by logistic regression analysis.The optimal critical point of FT3/FT4 for GDM prediction was determined by ROC.Results (1) Compared with NGT, patients with GDM were older, with higher BMI before pregnancy, higher FPG during the first trimester, but with lower weight gain during pregnancy [(32±5) vs (29±3)year,(23.15±3.11) vs (21.41 ±2.70)kg/m^2,(4.90±0.38) vs (4.67±0.33)mmol/L,(13.14±4.61) vs (14.94±4.78)kg,P<0.01].Compared with NGT, GDM groups had lower FT4 levels[1.23(1.13,1.30) vs 1.29 (1.19, 1.38) pg/ml, P<0.01] and higher FT3 levels[3.30 (3.04, 3.52) vs 3.17 (2.97,3.41) pg/ml, P<0.05] in early pregnancy.(2) Logistic regression analysis showed that FT4,FT3/FT4 in the first trimester were independent risk factors for GDM (OR 0.028,95% CI 0.003-0.312),(OR 5.014, 95% CI 1.818-13.826).(3) The ROC curve of GDM was performed with the FT3/FT4.The results showed that a diagnostic cut-off point for GDM was 2.5519, with a sensitivity and specificity of 70.0% and 60.5%, respectively.Conclusion The risk of GDM increased gradually with increasing age, pre-pregnancy BMI, FPG levels in early pregnancy.The risk of GDM increased gradually with decreasing FT4 and increasing FT3/FT4 in first trimester.When the FT3/FT4 in early pregnancy is greater than 2.5519, the risk of developing GDM is significantly increased.