妊娠期糖尿病妇女甲状腺功能与胰岛素抵抗及胰岛β细胞功能的相关性

The relationship between thyroid function,insulin resistance and isletβ-cell function in women with gestational diabetes mellitus

目的:探讨妊娠期糖尿病(GDM)妇女孕早期甲状腺功能指标与孕中期胰岛素抵抗水平及胰岛β细胞功能相关性。方法:收集676例GDM女性,分为未合并胰岛素抵抗GDM组(NIR-GDM,397例)和合并胰岛素抵抗GDM组(IR-GDM,279例),早孕期检测空腹血糖(FPG)、糖化血红蛋白(HbA1c)、三碘甲状腺原氨酸(T_(3))、甲状腺素(T_(4))、游离三碘甲状腺素(FT_(3))、游离甲状腺素(FT_(4))、促甲状腺激素(TSH)、抗甲状腺球蛋白抗体(TgAb)及甲状腺过氧化物酶抗体(TpoAb)。妊娠24~28周行75g OGTT及检测空腹胰岛素(FIns)。分析孕早期甲状腺功能指标与孕中期胰岛素抵抗水平及胰岛β细胞功能的关系。结果:IR-GDM组的孕早期体质量指数(BMI)、FPG、HbA1c及孕中期胰岛β细胞功能指数(HOMA-β)均高于NIR-GDM组(P<0.05)。Spearman相关分析显示,胰岛素抵抗指数(HOMA-IR)与T_(3)、FT_(3)、TSH呈正相关(P<0.05),与FT 4呈负相关(P<0.001);HOMA-β与T_(3)、FT_(3)/FT_(4)呈正相关(P<0.05),与FT_(4)呈负相关(P<0.001)。多元线性回归分析显示,年龄、孕早期BMI、T_(3)及FT_(4)是HOMA-IR、HOMA-β的影响因素。结论:孕早期甲状腺功能对GDM妇女孕中期胰岛素抵抗水平和胰岛β细胞功能产生重要影响。

Objective:To investigate the relationship between thyroid function in early pregnancy and insulin resistance in the second trimester of pregnancy and isletβ-cell function in women with gestational diabetes mellitus(GDM).Methods:676 women with GDM were divided into two groups:GDM group without insulin resistance(NIR-GDM,n=397)and GDM group with insulin resistance(IR-GDM,n=279).FPG,HbA1c,triiodothyronine(T_(3)),thyroxine(T_(4)),thyroid-stimulating hormone(TSH),free triiodothyronine(FT_(3)),free thyroxine(FT_(4)),thyroglobulin antibodies(TgAb)and thyroid peroxidase antibodie(TpoAb)were detected in early pregnancy.75g OGTT and fasting insulin(FIns)were performed at 24~28 weeks of gestation.The relationship between maternal thyroid function index in early pregnancy and insulin resistance in the second trimester and isletβ-cell function was analyzed.Results:BMI,FPG,HbA1c in early pregnancy and isletβcell function index(HOMA-β)in the second trimester of pregnancy in IR-GDM group were higher than those in NIR-GDM group(P<0.05).Spearman correlation analysis showed that HOMA-IR was positively correlated with T_(3),FT_(3)(P<0.05),TSH and negatively correlated with FT4(P<0.001),HOMA-βwas positively correlated with T_(3)and FT_(3)/FT 4(P<0.05),and negatively correlated with FT_(4)(P<0.001).Multiple linear regression analysis showed that age,BMI,T_(3)and FT_(4)in early pregnancy were the influencing factors of HOMA-IR and HOMA-β.Conclusion:In GDM women,thyroid function in early pregnancy has an important effect on insulin resistance and isletβ-cell function in the second trimester of pregnancy.