妊娠期甲状腺功能减退对糖脂代谢影响及左旋甲状腺素干预后妊娠结局

Effect of hypothyroidism of pregnant women during the pregnancy on maternal glucolipid metabolism and the pregnancy outcomes after intervention by levothyrocine

目的:分析妊娠早、中期甲状腺功能减退孕妇糖脂代谢的改变,探讨药物干预对妊娠结局的影响。方法:收集本院内分泌科就诊的妊娠期甲状腺功能减退患者临床资料,按照妊娠期甲状腺功能减退的不同类型分为临床型甲减、亚临床甲减及低甲状腺激素血症,另选产科常规产前检查甲状腺功能正常孕妇作为对照,分别比较妊娠早期和中期各组糖脂代谢指标,对临床型甲减及亚临床甲减孕妇给予左旋甲状腺素(L-T4)干预,比较各组妊娠结局。结果:妊娠早期,HbA1c及TG水平低甲状腺素血症组与对照组无差异,临床型与亚临床甲减组TG无差异(均P>0.05)、余组间有差异(P<0.05),各组FBG、TCH、HDL及LDL指标无差异(P>0.05);妊娠中期,FBG、HbA1c、TG及LDL,低甲状腺素血症组与对照组无差异,亚临床甲减组、低甲状腺素血症与对照组FBG及LDL无差异(均P>0.05),余组间两两比较均有差异(P<0.05),TCH及HDL各组间均无差异(P>0.05)。胎膜早破、妊娠期糖尿病及早产的发生率,甲减控制组、低甲状腺素血症组与对照组无差异(P>0.05),甲减未控制组高于另外3组(P<0.05),妊娠合并贫血、低出生体重儿、巨大儿及胎儿窘迫发生率各组间无差异(P>0.05)。结论:妊娠期期临床型甲减与亚临床甲减会导致母体糖脂代谢部分指标异常,以临床型甲减影响最显著;与妊娠早期比较,妊娠中期临床型甲减对糖脂代谢的影响更明显。应用L-T4治疗将TSH控制到理想水平可以改善妊娠结局,妊娠期低甲状腺激素血症对糖脂代谢及妊娠结局均无影响。

Objective:To analyze the changes of glucose and lipid metabolism of pregnant women with hypothyroidism during the first and the second trimester of pregnancy,and to explore the effect of drug intervention on pregnancy outcomes.Methods:The pregnant women with hypothyroidism were collected to been divided into group A(women with hypothyroxinemia),group B(women with subclinical hypothyroidism),and group C(women with hypothyroxinemia)according to the different types of hypothyroidism,and the pregnant women with normal thyroid function were selected in group D.The indexes of glucose and lipid metabolism of women during the first and second trimester of pregnancy were compared among these four groups.The women in group A and B were given L-T4 intervention,and the pregnancy outcomes of women were compared among the four groups.Results:During the first and second trimester of pregnancy,the levels of HbA1c and TG of women had no significant different between group C and D(P>0.05),but which had significant different among other groups(P<0.05).The TG level of women had no significant different between group A and B(P>0.05),but which had significant different among other groups(P<0.05).There were no significant different in the levels of FBG,TCH,HDL and LDL of women among the three groups(P>0.05).During the second trimester of pregnancy,the levels of FBG,HbA1c,TG and LDL had no significant different between group C and D(P>0.05),but which had significant different between group A and B(P<0.05).During the second trimester of pregnancy,the levels of FBG and LDL had no significant different among group B,C and D(P>0.05),but which had significant different between group A and B,between group A and C,or between group A and D(P<0.05).TCH and HDL levels of women had no significant different among the four groups(P>0.05).The incidences of premature rupture of membranes,gestational diabetes,and premature birth of women in group C had no significant different from those of women in group D(P>0.05),but were significant higher than those of women in group A and B(P<0.05).There were no significant different in the incidences of anemia during pregnancy,low birth weight,macrosomia,and fetal distress among the groups(P>0.05).Conclusion:The hypothyroidism and subclinical hypothyroidism during pregnancy can lead to the abnormal glucose and lipid metabolism,in which,the influence of hypothyroidism is higher.The influence of women with hypothyroidism on their glucose and lipid metabolism during the second trimester is more than that during the first trimester.The normal level of TSH by L-T4 treatment can improve the pregnancy outcomes.The hypothyroxinemia during pregnancy has no adverse effect on glucose and lipid metabolism and pregnancy outcomes.