妊娠期甲状腺功能减退症患者血清维生素B12、HCY水平变化及对妊娠结局的影响

Changes of serum vitamin B12 and homocysteine levels of pregnant women with hypothyroidism and their influence on pregnancy outcomes

目的:探究血清维生素B_(12)(VitB_(12))、同型半胱氨酸(HCY)水平与妊娠期甲状腺功能减退症的相关性。方法:选取2020年2月-2022年2月本院收治的妊娠期甲状腺功能减退症患者130例,分为妊娠期临床甲状腺功能减退症(临床组,56例)和妊娠期亚临床甲状腺功能减退症(亚临床组,74例),产前检查妊娠期甲状腺功能正常妇女60例对照组。比较3组空腹血糖(FBG)、餐后2 h血糖(2 h PG)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)、促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT_(3))和游离甲状腺素(FT_(4))和VitB_(12)、HCY水平;采用Person相关性分析VitB_(12)、HCY与甲状腺功能指标的相关性。根据患者妊娠结局分为不良妊娠结局组(110例)和正常妊娠结局组(20例),比较两组VitB_(12)、HCY水平。结果:临床组、亚临床组、对照组血清FBG、2 h PG、TC、TG、LDL-C、TSH和HCY水平依次降低,HDL-C、FT_(3)、FT_(4)和VitB_(12)依次升高(均P<0.05);VitB_(12)与TSH、FT_(3)和FT_(4)无相关性(P>0.05),HCY与TSH呈正相关、与FT_(3)和FT_(4)呈负相关(均P<0.05)。临床组、亚临床组妊娠期高血压疾病发生率(32.1%、32.4%)无差异但均高于对照组(5.0%),妊娠期糖尿病发生率(12.5%、10.8%)无差异但均高于对照组(0)(均P<0.05),不良妊娠结局发生率分别为83.9%和85.1%,均高于对照组的18.3%(P<0.05)。不良妊娠结局组VitB_(12)低于正常妊娠结局组,HCY高于正常妊娠结局组(均P<0.05)。结论:妊娠期甲状腺功能减退症患者血清VitB_(12)水平降低、HCY水平升高,两者可能参与了妊娠期甲状腺功能减退症的发生发展,并与不良妊娠结局有关。

Objective:To investigate the correlation between the levels of serum vitamin B_(12)(VitB_(12))and homocysteine(HCY)of pregnant women and their hypothyroidism.Methods:130 pregnant women with hypothyroidism were selected and were divided into group A(56 women with clinical hypothyroidism during pregnancy)and group B(74 women with subclinical hypothyroidism during pregnancy)according to the results of thyroid function examination from February 2020 to February 2022.Another 60 women with normal thyroid function during pregnancy were selected in group C.The levels of fasting blood glucose(FBG),2 h postprandial blood glucose(2 h PG),total cholesterol(TC),three acyl glycerol(TG),low density lipoprotein(LDL-C),and high density lipoprotein(HDL-C),thyroid stimulating hormone(TSH),free triiodothyronine(FT_(3)),free thyroxine(FT_(4)),VitB_(12),and Hcy of the women were compared among the three groups.Person correlation was used to analyze the correlation between the levels of VitB_(12) and HCY of the women and their thyroid function indexes levels.The women were also divided into 110 cases with adverse pregnancy outcomes in group D and 20 cases with normal pregnancy outcomes in group E according to the pregnancy outcomes of the women,and the VitB_(12)and HCY levels were compared between the two groups.Results:The levels of serum FBG,2hPG,TC,TG,LDL-C,TSH,and HCY of the women in group A,group B,and group C had decreased in turn,while the levels of HDL-C,FT_(3),FT_(4),and VitB_(12)had increased in turn(all P<0.05).There was no correlation between the VitB_(12)of the women in group A and group B and their levels of TSH,FT_(3),and FT_(4)(P>0.05).The HCY level of the women in group A and group B was positively correlated with their TSH level(P<0.05),but which was negatively correlated with their FT_(3)and FT_(4)levels(P<0.05).The incidence of gestational hypertension of the women in group A and group B(32.1%vs.32.4%)had no significant different,but which of the women in group A and group B was significantly higher than that(5.0%)of the women in group C.The incidence of gestational diabetes(12.5%vs.10.8%)had no significant different,but which of the women in group A and group B was significantly higher than that(0)of the women in group C(all P<0.05).The incidence of adverse pregnancy outcomes of the women in group A or group B was 83.93%or 85.14%,which was significantly higher than(18.3%)of the women in group C(P<0.05).The VitB_(12) level of the women in group D was significantly lower than that of the women in group E,and the HCY level of the women in group D was significantly higher than that of the women in group E(all P<0.05).Conclusion:The serum VitB_(12) level of the pregnant women with gestational hypothyroidism decreases,and their HCY level increases,both of which may be involved in the occurrence and development of gestational hypothyroidism and are closely related to their adverse pregnancy outcomes.