孕前体质量指数与孕期血脂、甲状腺激素的相关性及对妊娠期糖尿病患病的影响

Study on the Relationship between Pre-pregnancy Body Mass Index and Serum Lipid and Thyroid Hormone Levels during Pregnancy and Its Influence on the Incidence of Grestational Diabetes Mellitus

目的探讨孕前体质量指数(pBMI)异常与孕期血脂、甲状腺激素水平的相关性及对妊娠期糖尿病患病的影响。方法选取2021年7月至2022年12月于银川市妇幼保健院就诊的107例妊娠期糖尿病(GDM)患者为GDM组,另选择同期100例健康妊娠孕妇作为健康对照组,进行糖脂代谢指标和血清甲状腺激素检测。回顾性分析两组患者pBMI与血脂指标、血清甲状腺激素指标水平的相关性,采用多因素Logistic回归分析pBMI、血脂指标、甲状腺激素指标和GDM的相关性。结果与健康对照组相比,GDM组pBMI较高,差异有统计学意义(P<0.05);GDM组pBMI<18.5 kg·m^(-2)、18.5 kg·m^(-2)≤pBMI≤23.9 kg·m^(-2)占比较低,pBMI>23.9 kg·m^(-2)占比较高(P<0.05);GDM组三酰甘油(TG)、低密度脂蛋白胆固醇(TDL-C)水平升高,高密度脂蛋白胆固醇(HDL-C)水平降低(P均<0.05);GDM组三碘甲状腺原氨酸(T3)、游离甲状腺素(FT4)水平降低(P<0.05),促甲状腺刺激激素(TSH)水平升高(P<0.05),甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)水平两组比较差异均无统计学意义(P均>0.05)。pBMI与TG、LDL-C、TSH水平均呈正相关,与HDL-C、T3、FT4水平均呈负相关(P均<0.05)。Logistic回归分析结果显示,pBMI≥24.0 kg·m^(-2)、TG≥1.7 mmol·L^(-1)、LDL-C≥1.55 mmol·L^(-1)、TSH≥4.2μIU·mL^(-1),HDL-C<1.9 mmol·L^(-1)、T3<1.3 nmol·L^(-1)、FT4<12 pmol·L^(-1)均为GDM发生的危险因素(P均<0.05)。结论pBMI升高与血脂、甲状腺激素指标密切相关,在GDM的发生发展中均起着至关重要的作用,动态监测血脂、甲状腺激素水平变化值得临床重点关注。

Objective To investigate the correlation between abnormal prepregnancy body mass index(BMI)and the levels of blood lipid and thyroid hormone during pregnancy and its influence on the incidence of gestational diabetes mellitus.Methods A total of 107 patients with gestational diabetes mellitus(GDM)treated in our hospital from July 2021 to December 2022 were selected as GDM group.Another 100 healthy pregnant women in the same period were selected as healthy control group.Glucose and lipid metabolism indexes were detected,and the serum thyroid hormone level was monitored.Retrospective analysis was conducted on two groups of pre pregnancy body mass index(pBMI),blood lipid indicators,serum thyroid hormone levels,and the correlation between pBMI and blood lipid and thyroid hormone indicators.Multivariate Logistic regression was used to analyze the correlation between pBMI,blood lipid indicators,thyroid hormone indicators,and GDM.Results Compared with healthy control group,pBMI in GDM group was higher,and the difference was statistically significant(P<0.05).Compared with the healthy control group,pBMI<18.5 kg·m^(-2),18.5 kg·m^(-2)≤pBMI≤23.9 kg·m^(-2)were lower in the GDM group,and pBMI>23.9 kg·m^(-2)was higher in the GDM group(P<0.05).Compared with the healthy control group,TG and LDL-C levels were increased in the GDM group,the HDL-C level was decreased(P all<0.05).Compared with the healthy control group,the levels of T3 and FT4 in GDM group were lower(P<0.05),and the levels of TSH were higher(P<0.05).There were no significant differences in T4 and FT3 levels between the two groups(P all>0.05).Pearson correlation analysis showed that pBMI was positively correlated with TG,LDL-C and TSH levels,but negatively correlated with HDL-C,T3 and FT4 levels(P all<0.05).Multivariate Logistic regression analysis showed that pBMI≥24.0 kg·m^(-2)、TG≥1.7 mmol·L^(-1)、LDL-C≥1.55 mmol·L^(-1)、TSH≥4.2μIU·mL^(-1),HDL-C<1.9 mmol·L^(-1)、T3<1.3 nmol·L^(-1)、FT4<12 pmol·L^(-1)were all risk factors for GDM(P all<0.05).Conclusion pBMI elevation is closely related to lipid and thyroid hormone indexes,and play a crucial role in the occurrence and development of GDM.Dynamic monitoring of lipid and thyroid hormone levels is worthy of clinical attention.