血清apelin、FGF-21与妊娠期合并亚临床甲状腺功能减退症孕妇脂代谢和甲状腺激素的关系

Relationship between serum apelin,FGF-21 and lipid metabolism,thyroid hormone in pregnant women with subclinical hypothyroidism

目的探讨妊娠期合并亚临床甲状腺功能减退症(SuHT)孕妇血清apelin、成纤维细胞生长因子-21(FGF-21)与脂代谢和甲状腺激素的关系。方法选择2016年3月至2019年5月安康市妇幼保健院收治的75例妊娠期合并SuHT孕妇为观察组,另选择同期到安康市妇幼保健院行产检的75例健康孕妇为对照组,采用酶联免疫吸附试验测定血清apelin、FGF-21水平,采用全自动生化分析仪检测总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白A(ApoA)和载脂蛋白B(ApoB)水平,采用化学发光法检测促甲状腺激素(TSH)、游离甲状腺素(FT4)、游离三碘甲腺原氨酸(FT3)水平,比较两组孕妇以上各指标水平的差异,Pearson相关性分析法分析血清apelin、FGF-21与TC、TG、HDL、LDL、ApoA、ApoB、TSH的相关性,记录两组孕妇的妊娠结局。结果观察组孕妇的TC、TG、LDL、TSH、apelin及FGF-21水平明显高于对照组,差异均有统计学意义(P<0.05);观察组孕妇的FT3、FT4、HDL、ApoA、ApoB水平分别与对照组比较差异均无统计学意义(P>0.05);Pearson相关性分析结果显示,血清apelin、FGF-21水平与TC、TG、LDL、TSH呈正相关(P<0.05),而与FT3、FT4、HDL、ApoA、ApoB水平无相关性(P>0.05);观察组孕妇的不良妊娠结局的发生率为18.67%,明显高于对照组的6.67%,差异有统计学意义(P<0.05)。结论妊娠期SuHT孕妇存在较为轻微的脂代谢及甲状腺激素分泌异常,其血清apelin、FGF-21水平异常升高,且与TC、TG、LDL、TSH呈正相关,检测妊娠期SuHT孕妇血清apelin、FGF-21水平可反映其脂代谢和甲状腺激素水平,apelin、FGF-21可作为辅助临床诊断妊娠期SuHT及预估不良妊娠结局风险的指标。

Objective To explore the relationship between serum apelin,fibroblast growth factor-21(FGF-21)and lipid metabolism,thyroid hormone in pregnant women with subclinical hypothyroidism(SuHT).Methods A total of 75 cases of pregnant women with SuHT,who admitted to Ankang Maternal and Child Health Hospital from March 2016 to May 2019,were selected as the observation.In addition,75 healthy pregnant women who came to Ankang Maternal and Child Health Hospital during the same period were selected as the control group.The serum levels of apelin and FGF-21 were measured by enzyme-linked immunosorbent assay.The levels of total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL),low-density lipoprotein cholesterol(LDL),apolipoprotein A(ApoA)and apolipoprotein B(ApoB)were measured by automatic biochemical analyzer.The levels of thyroid stimulating hormone(TSH),free tetraiodothyronine(FT4)and free triiodothyronine(FT3)were measured by chemiluminescence method.The differences of each index level between the two groups were compared.Pearson correlation analysis was used to analyze the correlation between serum apelin,FGF-21 and TC,TG,HDL,LDL,ApoA,ApoB,TSH.The pregnancy outcomes of the two groups were recorded.Results The levels of TC,TG,LDL,TSH,apelin,and FGF-21 in the observation group were significantly higher than those in the control group(all P<0.05);the levels of FT3,FT4,HDL,ApoA,and ApoB in the observation group were significantly higher than those in the control group(all P>0.05).Pearson correlation analysis showed that serum apelin and FGF-21 levels were positively correlated with TC,TG,LDL and TSH(all P<0.05),but not with FT3,FT4,HDL,ApoA,ApoB levels(all P>0.05).The incidence of adverse pregnancy outcomes in the observation group was 18.67%,which was significantly higher than 6.67%in the control group(P<0.05).Conclusion The pregnant women with SuHT have slight abnormal lipid metabolism and thyroid hormone secretion,and the levels of serum apelin and FGF-21 are increased abnormally,which are positively correlated with TC,TG,LDL,and TSH.The detection of serum apelin and FGF-21 can reflect the lipid metabolism and thyroid hormone level of pregnant women with SuHT,and apelin and FGF-21 can be used as indicators to assist clinical diagnosis of pregnant women with SuHT and estimate the risk of adverse pregnancy outcome.