妊娠期合并甲状腺功能亢进孕妇甲状腺功能指标的变化及其对母婴结局的影响

Change of thyroid function index in pregnant women with hyperthyroidism and its influence to maternal and infant outcome

目的探讨妊娠期合并甲状腺功能亢进孕妇甲状腺功能指标的变化及其对母婴结局的影响.方法抽取2013年2月至2018年5月于太原市太钢总医院进行孕检的526例孕妇为研究对象,选择其中妊娠期合并甲亢孕妇201例为研究组,甲状腺功能正常孕妇325例为对照组,对两组孕妇甲状腺功能指标、脂质代谢指标及糖代谢指标进行检测,并比较两组孕妇妊娠结局及新生儿结局.结果研究组孕妇血清促甲状腺激素水平低于对照组,游离甲状腺素、游离三碘甲腺原氨酸、促甲状腺素受体抗体水平高于对照组(P<0.05);研究组孕妇的载脂蛋白A-I、高密度脂蛋白胆固醇低于对照组,三酰甘油、总胆固醇水平高于对照组(P<0.05);研究组孕妇空腹胰岛素、空腹血糖水平、胰岛素敏感指数、胰岛素抵抗指数绝对值水平高于对照组(P<0.05);研究组孕妇流产引产率、剖宫产率高于对照组,阴道分娩率低于对照组(P<0.05);研究组孕妇流产引产率、剖宫产率高于对照组,阴道分娩率低于对照组(P<0.05);研究组孕妇新生儿甲亢、低体质量儿及死胎的发生率高于对照组(P<0.05).结论妊娠期合并甲亢孕妇的甲状腺功能指标均存在异常变化,且会导致糖脂代谢紊乱及引发不良妊娠、新生儿结局,检测甲状腺功能指标并对诊断甲亢及改善孕妇母婴结局具有指导作用.

Objective To investigate the change of thyroid function index in pregnant women with hyperthyroidism and its influence to maternal and infant outcome.Methods A total of 526 pregnant women who underwent pregnancy examination in General Hospital of Taiyuan Iron&Steel Group from Februang 2013 to May 2018 were selected as research objects.According to whether hyperthyroidism was combined with hyperthyroidism,they were divided into study group(with hyperthyroidism,201 cases)and control group(with non-hyperthyroidism,325 cases).Thyroid function index,lipid metabolism index and glucose metabolism index of pregnant women in both groups were measured.Pregnancy outcomes and neonatal outcomes were compared between the two groups.Results The serum thyroid stimulating hormone level of pregnant women in the study group was significantly lower than that of the control group,and the levels of free thyroxine,free triiodothyronine and thyrotropin receptor antibodieswere significantly higher than those of the control group(P<0.05).Apolipoprotein A-I and high density lipoprotein cholesterol levels of pregnant women in the study group were significantly lower than those in the control group,triglyceride,total cholesterol levels were significantly higher than those in the control group(P<0.05).The absolute values of fasting insulin,fasting blood sugar,insulin sensitivity index and insulin resistance index absolute values of pregnant women in the study group were significantly higher than those in the control group(P<0.05).The abortion and cesarean section rates of pregnant women in the study group were significantly higher than those in the control group,and the vaginal delivery rates were significantly lower than those in the control group(P<0.05).The abortion and cesarean section rates of pregnant women in the study group were significantly higher than those in the control group,and the vaginal delivery rates were significantly lower than those in the control group(P<0.05).The incidence of neonatal hyperthyroidism,low birth weight and stillbirth in the study group were higher than those in the control group(P<0.05).Conclusions Thyroid function indicators of pregnant women with hyperthyroidism during pregnancy have abnormal changes,which can lead to disorders of glucose and lipid metabolism,adverse pregnancy outcomes and neonatal outcomes.Detection of thyroid function indicators can guide the diagnosis of hyperthyroidism and improve maternal and neonatal outcomes of pregnant women.