妊娠期糖尿病合并甲状腺功能减退孕妇相关指标变化及不良妊娠结局发生情况

The Changes and Adverse Pregnancy Outcomes in Pregnant Women with Gestational Diabetes Mellitus Combined with Hypothyroidism

目的:探讨妊娠期糖尿病(GDM)合并甲状腺功能减退(甲减)孕妇凝血功能、炎性因子、脂肪细胞因子变化及不良妊娠结局发生情况。方法:选取2019年5月—2020年10月在上海金山区亭林医院进行治疗的360例孕妇为研究对象,将其分为A、B、C 3组进行研究。其中,A组120例,为妊娠期糖尿病合并甲减孕妇;B组120例,为妊娠期糖尿病无甲减孕妇;C组120例,为正常健康孕妇。比较3组孕妇甲状腺功能指标、凝血功能指标、炎性因子水平及不良妊娠结局发生率。结果:3组孕妇血清促甲状腺激素(TSH)、游离甲状腺激素(FT4)、游离三碘甲状腺氨酸(FT3)含量比较,差异有统计学意义(F值分别为368.475、342.977和216.829,P值均<0.01)。3组孕妇活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、抗凝血酶Ⅲ(ATⅢ)水平比较,差异有统计学意义(F值分别为6.857、74.972和8.835,P值均<0.01)。3组孕妇白细胞介素6 (IL-6)、肿瘤坏死因子α (TNF-α)水平比较,差异有统计学意义(F值分别为58.419和127.022,P值均<0.01)。3组孕妇瘦素、脂联素(APN)水平比较,差异有统计学意义(F值分别为598.425和180.959,P值均<0.01)。A组孕妇产后出血、早产、胎膜早破、低体重儿、妊娠期高血压等不良妊娠结局的发生率均高于C组孕妇,差异有统计学意义(P<0.05)。结论:GDM合并甲减孕妇存在凝血功能异常,IL-6、TNF-α等炎性因子水平升高,不良妊娠结局发生风险较高。

OBJECTIVE To study the changes of coagulation function indexes and inflammatory factors in pregnant women with gestational diabetes mellitus complicated with hypothyroidism and their influence on pregnancy outcome. METHODS A total of 360pregnant women treated in Tinglin Hospital, Jinshan district, Shanghai from May 2019 to October 2020 were selected and divided into groups A, B and C 3 for the study. Among them, 120 patients in group A were pregnant women with gestational diabetes, 120 patients in group B were pregnant women without hypothyroidism, and 120 patients in Group C were normal and healthy pregnant women. Comparison of thyroid function, coagulation function, levels of inflammatory factors and incidence of adverse pregnancy outcomes in group 3 pregnant women. RESULTS The content of serum thyroid stimulating hormone(TSH), free thyroid hormone(FT4) and free triiodothyroidine(FT3)(F=368.475, 342.977, 216.829, P<0.01). Three pregnant women had activated partial thrombin time(APTT),fibrinogen(FIB), and antithrombin(AT) levels(F= 6.857,74.972, 8.835, P<0.01). The levels of interleukin 6(IL-6) and tumor necrosis factor α(TNF-α) were significantly different(F=58.419, 127.022, P<0.01). The difference between leptin and adiponectin(APN) levels was significant(F=598.425, 180.959, P<0.01). The incidence of adverse pregnancy outcomes such as postpartum bleeding, premature birth, premature rupture of membranes, low body weight infants, and gestational hypertension was higher than that in group C, and the difference was statistically significant(P<0.05). CONCLUSION Pregnant women with gestational diabetes and hypothyroidism have abnormal blood coagulation function, and the level of IL-6, TNF-α and other inflammatory factors increases, which increases the risk of adverse pregnancy outcomes.