妊娠期甲状腺功能异常与血脂代谢和妊娠结局的相关性研究

Study on the correlation between thyroid dysfunction during pregnancy and blood lipid metabolism and pregnancy outcome

目的分析妊娠期甲状腺功能异常对血脂代谢和妊娠结局的影响。方法本研究为前瞻性研究, 选取2020年1月至2021年5月郑州大学第三附属医院产科收治的116例妊娠期甲状腺功能异常的患者, 年龄(29.68±5.21)岁, 年龄范围为22~38岁。根据患者病情分为甲状腺功能减退(以下简称"甲减")组(n=38)、亚临床甲减组(n=49)、甲状腺功能亢进(以下简称"甲亢")组(n=29), 同期选择50例正常孕期检查的孕妇作为正常组。测定所有孕妇的总胆固醇、甘油三酯、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)、空腹血糖、口服葡萄糖75 g后1小时血糖(PBG 1 h)和口服葡萄糖75 g后2小时血糖(PBG 2 h)水平。记录所有孕妇的一般临床资料, 并记录妊娠期糖尿病等不良妊娠结局发生率。结果正常组孕妇的总胆固醇、甘油三酯、LDL-C水平低于甲减组、亚临床甲减组、甲亢组, 而HDL-C水平高于甲减组、亚临床甲减组、甲亢组, 差异均有统计学意义(P<0.05)。正常组孕妇的空腹血糖、PBG 1 h、PBG 2 h水平低于甲减组、亚临床甲减组、甲亢组, 差异有统计学意义(P<0.05)。正常组孕妇不良妊娠结局发生率[4.0%(2/50)]低于甲减组[23.7%(9/38)]、亚临床甲减组[24.5%(12/49)]、甲亢组[24.1%(7/29)], 差异有统计学意义(P<0.05)。甲状腺功能异常与血脂代谢异常和不良妊娠结局呈显著正相关, 差异有统计学意义(P<0.05)。结论妊娠期甲状腺功能异常会加重血脂代谢异常, 并导致不良妊娠结局。

Objective To analyze the influence and correlation of thyroid dysfunction during pregnancy on blood lipid metabolism and pregnancy outcome.Methods This study was a was a prospective study.From January 2020 to May 2021,a total of 116 pregnant patients with thyroid dysfunction admitted to the department of Obstetrics of the Third Affiliated Hospital of Zhengzhou University were selected,all of whom were female,aged(29.68±5.21)years old,ranging from 22 to 38 years old.Patients were divided into hypothyroidism group(n=38),subclinical hypothyroidism group(n=49)and hyperthyroidism group(n=29)according to their conditions,50 pregnant women with normal pregnancy were selected as the normal group.Total cholesterol,triglyceride,low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),fasting blood glucose,postprandial blood glucose(PBG 1 h)and postprandial blood glucose(PBG 2 h)after 75 g oral glucose were measured.General clinical data of all pregnant women were recorded,and the incidence of adverse pregnancy outcomes such as gestational diabetes was recorded.Results The levels of total cholesterol,triglyceride and LDL-C in normal group were lower than those in hypothyroidism group,subclinical hypothyroidism group and hyperthyroidism group,while HDL-C level was higher than those in hypothyroidism group,subclinical hypothyroidism group and hyperthyroidism group,the differences were statistically significant(P<0.05).The levels of fasting blood glucose,PBG 1 h and PBG 2 h in normal group were lower than those in hypothyroidism group,subclinical hypothyroidism group and hyperthyroidism group,and the differences were statistically significant(P<0.05).The incidence of adverse pregnancy outcomes in normal group[4.0%(2/50)]was lower than that in hypothyroidism group[23.7%(9/38)],subclinical hypothyroidism group[24.5%(12/49)]and hyperthyroidism group[24.1%(7/29)],and the difference was statistically significant(P<0.05).Thyroid dysfunction was significantly positively correlated with dyslipidemia and adverse pregnancy outcome(P<0.05).Conclusions Thyroid dysfunction during pregnancy can aggravate abnormal blood lipid metabolism and lead to adverse pregnancy outcomes.