妊娠糖尿病孕妇妊娠早期甲状腺激素中枢敏感性对巨大儿的预测价值

Predictive value of thyroid hormone central sensitivity in early pregnancy on macrosomia in pregnant women with gestational diabetes mellitus

目的探讨妊娠期糖尿病(GDM)孕妇妊娠早期甲状腺激素中枢敏感性对巨大儿发生的影响及预测价值。方法选取2020年1月至2021年5月在南方医科大学南方医院产科门诊行规律产前检查、符合入排标准的GDM孕妇。根据甲状腺反馈分位数(TFQI)评估甲状腺激素中枢敏感性。通过多因素Logistic回归分析筛选独立危险因子,建立Logistic回归预测模型。采用受试者操作特征(ROC)曲线评价预测模型价值并寻找相应切点。结果共纳入GDM孕妇249例,按照新生儿出生体质量分为巨大儿组(9例,出生体质量≥4000 g)和非巨大儿组(240例,出生体质量<4000 g)。(1)与非巨大儿组相比较,巨大儿组的妊娠早期TFQI更小[(-0.03±0.32)vs(-0.32±0.28),P<0.05],孕中期糖化血红蛋白水平更高[5.20(5.00~5.50)vs 5.40(05.30~5.90),P<0.05],75 g口服葡萄糖耐量试验餐后2 h血糖(OGTT 2h PG)也更高[(8.96±1.43)vs(10.19±1.80),P<0.05],差异均有统计学意义。(2)75 g OGTT 2h PG(OR=1.569)是GDM孕妇巨大儿发生的独立危险因素,妊娠早期TFQI较高(OR=0.025)是GDM孕妇巨大儿发生的保护因素(均P<0.05)。(3)ROC结果显示,包括TFQI、75 g OGTT 2h PG、糖化血红蛋白的预测模型的曲线下面积为0.819,敏感度为66.7%,特异度89.9%,模型中各指标预测巨大儿发生的界值分别为-0.240、11.265 mmol/L、5.250%。结论(1)在GDM孕妇中,妊娠早期TFQI的降低,孕中期75 g OGTT 2h PG升高这2项指标是发生巨大儿的独立危险因素;(2)当TFQI<-0.240、75 g OGTT 2h PG>11.265 mmol/L、糖化血红蛋白>5.250%时,GDM孕妇发生巨大儿的风险显著增加。

Objective To investigate the influence and predictive value of central sensitivity of thyroid hormone in early pregnancy on macrosomia in pregnant women with gestational diabetes mellitus(GDM).MethodsPatients with GDM who conducted regular antenatal examinations at the Obstetrics department of Nanfang Hospital,Southern Medical University from January 2020 to May2021 and met the criteria for admission were selected.Central sensitivity of thyroid hormones was assessed according to thyroid feedback quantile index(TFQI).Logistic regression and receiveroperating-characteristics(ROC)curve analyses were carried out to identify independent predictors of macrosomia and to build a prediction model.ResultsIn total,249 pregnancies with GDM were included(9 with macrosomia and 240 without).(1)In macrosomia group compared with the controls,TFQI in the early preganacy was lower[(-0.03±0.32)vs(-0.32±0.28),P<0.05],the Hb A1 c in second-trimester was higher[5.20(5.00 to 5.50)vs 5.40(5.30 to 5.90),P<0.05],and the 75 g OGTT 2 h PG was higher as well[(8.96±1.43)vs(10.19±1.80),P<0.05].(2)75 g OGTT 2 h PG(OR=1.569)was independent risk factors for the macrosomia,while TFQI(OR=0.025)was a protective factor(both P<0.05).(3)The prediction model integrating TFQI,75 g OGTT 2 h PG,and Hb A1 c provided an area under the ROC curve(AUC)of 0.819,a sensitivity of 66.7%,and a specificity of 89.9%,and the cut-off values for each index in the model were-0.240,11.265 mmol/L,and 5.250%,respectively.Conclusions(1)TFQI measured in early pregnancy is associated independently with and is predictive of macrosomia in patients with GDM.(2)When TFQI<-0.240,75 g OGTT 2 h PG>11.265 mmol/L,and glycosylated hemoglobin>5.250%,the risk of macrosomia in GDM patients was significantly increased.