甲状腺功能指标与妊娠期糖尿病的相关性研究

Correlation of indexes of thyroid function with gestational diabetes mellitus

目的分析甲状腺功能指标与妊娠期糖尿病(GDM)的相关性。方法抽取2021年1月至2021年6月于郑州市第一人民医院行定期产检的孕妇400例,根据口服葡萄糖耐量试验结果,将其分为GDM组160例和对照组(非GDM)240例。于孕10~14、15~26、27~32、33~40周检测血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平,并计算FT3/FT4。应用Logistic分析研究GDM的风险因素,绘制受试者工作特征曲线分析甲状腺功能指标预测GDM的最佳临界点。结果GDM组体质指数高于对照组(P<0.05),糖尿病家族史患者多于对照组(P<0.05)。孕10~14周,GDM组FT3、FT3/FT4高于对照组(P<0.05)。Logistic分析结果显示,孕10~14周,FT3、FT3/FT4升高是GDM发生的影响因素(OR=6.69、12.52,P=0.002、0.034)。受试者工作特征曲线显示,FT3以5.085 pmol/L作为切点时,预测GDM的敏感度为60.0%,特异性为79.0%;FT3/FT4以0.305作为切点时,预测GDM的敏感性为74.3%,特异性为66.7%。结论孕早期甲状腺功能与GDM的发生存在一定相关性,FT3和FT3/FT4升高是孕妇发生GDM的危险因素。

Objective To analyze the correlation of indexes of thyroid function with gestational diabetes mellitus(GDM).Methods A total of 400 pregnant women who received regular antenatal examination in Zhengzhou First People’s Hospital from January 2021 to June 2021 were selected.According to the results of oral glucose tolerance test,they were divided into GDM group(160 cases)and control group(non-GDM,240 cases).Serum levels of free triiodothyronine(FT3),free thyroxine(FT4)and thyroid stimulating hormone(TSH)were detected at 10-14,15-26,27-32,33-40 weeks of pregnancy,and FT3/FT4 was calculated.Logistic analysis was used to analyze the risk factors of GDM,and the receiver operating characteristic curve was drawn to analyze the optimal critical point of GDM indicators.Results The body mass index of the GDM group was higher than that of the control group(P<0.05),and the number of patients with family history of diabetes in the GDM group was higher than that in the control group(P<0.05).From 10 to 14 weeks of pregnancy,the FT3 and FT3/FT4 in the GDM group were higher than those in the control group(P<0.05).Results of Logistic analysis showed that the increase of FT3 and FT3/FT4 during 10-14 weeks of pregnancy were the influencing factors of GDM(OR=6.69,12.52;P=0.002,0.034).The receiver operating characteristic curve showed that when FT3 was set as the cut-off point of 5.085 pmol/L,the sensitivity of it in predicting GDM was 60.0%,and the specificity was 79.0%;when FT3/FT4 was set as the cut-off point of 0.305,the sensitivity of it in predicting GDM was 74.3%,and the specificity was 66.7%.Conclusions There is a certain correlation between thyroid function and the occurrence of GDM in the first trimester of pregnancy,and the increase of FT3 and FT3/FT4 are risk factors of GDM.