妊娠期糖尿病孕妇68例甲状腺功能和亚甲基四氢叶酸还原酶基因多态性分析

Clinical significance of thyroid function and MTHFR gene polymorphism in 68 pregnant women with gestational diabetes mellitus

目的分析68例妊娠期糖尿病孕妇甲状腺功能和亚甲基四氢叶酸还原酶(MTHFR)基因多态性及临床意义。方法对2020年5月至2021年5月于河南省平顶山市妇幼保健院产科进行分娩的68例妊娠期糖尿病孕妇临床资料进行回顾性分析,将其作为研究组,另回顾性分析50名同期于平顶山市妇幼保健院进行分娩的健康孕妇的临床资料,将其作为对照组。将2组研究对象血清同型半胱氨酸(Hcy)、血清游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺激素(TSH)水平及MTHFR基因多态性进行检测并对比,采用Pearson相关分析研究组患者甲状腺功能指标和血清Hcy的相关关系,采用二元Logistic回归分析对妊娠期糖尿病发病的高危因素进行分析。结果2组研究对象基因型频率对比,差异有统计学意义(P<0.05),其中研究组患者TT、TC基因型频率较对照组升高,而CC基因型频率较对照组下降(P均<0.05),研究组患者T等位基因频率为62%,C等位基因频率为38%,相较于对照组的28%、72%,差异均有统计学意义(P均<0.05);研究组患者血清Hcy、TSH水平相较于对照组上升(P均<0.05),而2组研究对象FT3、FT4水平对比,差异无统计学意义(P均>0.05);研究组患者血清Hcy与FT3、FT4无相关关系(P均>0.05),而与TSH呈正相关(r=0.446,P<0.05);二元Logistic回归分析结果显示,妊娠期糖尿病发生的高危因素为Hcy、TSH水平上升(OR=0.857、0.385,P均<0.05)。结论妊娠期糖尿病孕妇甲状腺功能和MTHFR基因多态性存在相关关系,在进行备孕时可对MTHFR基因C677T进行检测,针对存在基因突变的女性,应在妊娠期对甲状腺功能指标、血清Hcy水平密切监测,对于Hcy、TSH水平较高的女性,可采取适当的措施进行干预,以降低妊娠期糖尿病的发生率。

Objective To analyze the thyroid function and methylenetetrahydrofolate reductase(MTHFR)gene polymorphisms and their clinical significance in 68 pregnant women with gestational diabetes mellitus.Methods The clinical data of 68 pregnant women with gestational diabetes who gave birth in the obstetrics department of Pingdingshan Maternal and Child Health Hospital from May 2020 to May 2021 were retrospectively analyzed as the study group,and the clinical data of 50 healthy pregnant women who gave birth in the same period were retrospectively analyzed as the reference group.The levels of serum homocysteine(Hcy),serum free triodothyronine(FT3),free thyroxine(FT4)and thyroid stimulating hormone(TSH),and MTHFR gene polymorphism were detected and compared between the two groups.The correlation between thyroid function index and serum Hcy was analyzed by Pearson correlation software,and the risk factors of gestational diabetes were analyzed by binary Logistic regression analysis.Results There was a statistical significance in the comparison of genotype frequencies between the two groups(P<0.05).The TT and TC genotype frequencies in the study group were significantly increased compared with the reference group,while the CC genotype frequencies were significantly decreased compared with the reference group(all P<0.05).The T allele frequencies in the study group were 62%.The C allele frequency was 38%,compared with 28%and 72%in the reference group,and the differences were statistically significant(all P<0.05).The levels of serum Hcy and TSH levels in the study group were significantly increased compared with that in the reference group(all P<0.05),while FT3 and FT4 levels were not significantly different between the two groups(all P>0.05).There was no significant correlation between serum Hcy and FT3 and FT4 in the study group patients(both P>0.05),but while serum Hcy was positively correlated with TSH(r=0.446,P<0.05).The results of binary Logistic regression analysis showed that the high risk factors of gestational diabetes were the increase of Hcy and TSH levels(OR=0.857,0.385,both P<0.05).Conclusion There is a certain correlation between thyroid function and MTHFR gene polymorphism in pregnant women with gestational diabetes mellitus.MTHFR gene C677T can be detected during pregnancy preparation,while for women with gene mutation,thyroid function index and serum Hcy level should be closely monitored during pregnancy.For women with high Hcy and TSH levels,Appropriate interventions can be taken to reduce the incidence of gestational diabetes.