甲状腺功能减退对妊娠期糖尿病患者妊娠结局的影响分析

Influence of hypothyroidism on pregnancy outcomes in patients with gestational diabetes mellitus

目的探讨甲状腺功能减退对妊娠期糖尿病患者妊娠结局的影响。方法选取本院收治的122例妊娠期糖尿病患者为研究对象,根据甲状腺检查结果将其分为非甲减组(n=65)与甲减组(n=65)。比较两组患者的甲状腺功能指标与胰岛素相关指标,并比较两组患者的妊娠结局与并发症发生情况。结果甲减组的促甲状腺激素(TSH)、甲状腺过氧化物酶抗体(TPOAb)、稳态模式胰岛素抵抗指数(HOMA-IR)、空腹胰岛素(FINS)水平均显著高于非甲减组,游离三碘甲状腺原氨酸(FTs)、游离四碘甲状腺原氨酸(FT_(4))、胰岛素敏感性指数(ISI)水平均显著低于非甲减组,差异有统计学意义(P<0.05)。甲减组患者的产后出血及巨大儿发生率分别为13.85%、15.39%,显著高于非甲减组的3.08%、4.62%,差异有统计学意义(P<0.05);两组的先兆子痫、胎膜早破、早产、剖宫产、胎儿窘迫、生长受限、极低体重儿发生率比较,差异无统计学意义(P>0.05)。结论甲减可导致妊娠期糖尿病患者胰岛素抵抗,增加产后出血及巨大儿的发生率,故临床应结合症状采取措施预防甲减。

Objective To investigate the effect of hypothyroidism on pregnancy outcome in patients with gestational diabetes mellitus.Methods A total of 122 patients with gestational diabetes mellitus admitted to our hospital were selected as the research objects.According to the results of thyroid examination,they were divided into the non-hypothyroidism group(n=65)and the hypothyroidism group(n=65).The indicators of hypothyroidism and insulin-related were compared between the two groups,and the pregnancy outcomes and complications were compared between the two groups.Results The levels of thyroid stimulating hormone(TSH),thyroid peroxidase antibody(TPOAb),homeostasis model assessment-insulin resistance(HOMA-IR)and fasting insulin(FINS)in hypothyroidism group were significantly higher than those in non-hypothyroidism group,the levels of free triiodothyronine(FT3),free tetraiodothyronine(FT4)and insulin sensitivity index(ISI)were significantly lower than those in non-hypothyroidism group,and the differences were statistically significant(P<0.05).The incidence of postpartum hemorrhage and macrosomia in hypothyroidism group were 13.85%and 15.39%,respectively,which were significantly higher than 3.08%and 4.62%in non-hypothyroidism group,the differences were statistically significant(P<0.05);there were no significant differences in the incidences of preeclampsia,premature rupture of membranes,premature delivery,cesarean section,fetal distress,growth restriction and very low birth weight infants between the two groups(P>0.05).Conclusion Hypothyroidism can lead to insulin resistance and increase the incidence of postpartum hemorrhage and macrosomia in patients with gestational diabetes mellitus.Therefore,measures should be taken to prevent hypothyroidism in combination with symptoms.