妊娠期亚临床甲减患者妊娠期间及产后25(OH)D_(3)、鸢尾素、骨密度测定与分析

The Determination and Analysis of 25(OH)D_(3),Irisin and BoneMineral Density in Subclinical Hypothyroidism DuringPregnancy and Postpartum

目的探究妊娠期亚临床甲减患者妊娠期间及产后25-羟维生素D[25(OH)D]、鸢尾素及骨密度(BMD)水平及相关性。方法选取2020年6月至2022年1月本院接诊的亚临床甲减孕妇,共计160例,将其纳入研究组并开展研究,另选取同期于本院接受体检健康孕妇作为对照组,检测所有产妇妊娠中期和产后6周时、25(OH)D_(3)、鸢尾素和BMD水平;记录所有产妇妊娠不良结局发生情况;对比妊娠期间和产后6周对照组和研究组孕妇促甲状腺素(TSH)、25(OH)D_(3)、鸢尾素及BMD水平;对比不同妊娠结局产妇25(OH)D_(3)、鸢尾素、BMD和TSH水平;分析妊娠结局与25(OH)D_(3)、鸢尾素、BMD和TSH相关性;分析25(OH)D_(3)、鸢尾素及BMD与TSH相关性。结果研究组25(OH)D_(3)、BMD均明显低于对照组,鸢尾素明显高于对照组(均P<0.05);对照组发生妊娠不良发生率为6.88%(11/160),明显低于研究组25.63%(41/160)(P<0.05);妊娠不良组产妇25(OH)D_(3)、BMD均明显低于妊娠良好组,鸢尾素明显高于妊娠良好组(均P<0.05);25(OH)D_(3)和骨密度与妊娠结局之间呈显著正相关,鸢尾素和TSH与妊娠结局之间呈显著负相关(均P<0.05);产后6周,对照组和研究组25(OH)D_(3)差异并不显著(P>0.05);对照组鸢尾素显著低于研究组,BMD显著高于对照组(均P<0.05);Pearson分析结果显示TSH与25(OH)D_(3)和BMD呈负相关,与鸢尾素呈显著正相关(均P<0.05)。结论妊娠期亚临床甲减患者妊娠中期和产后6周鸢尾素和骨代谢均表现异常,且与妊娠结局有明显相关性,临床应给予亚临床甲减孕妇适当干预,以降低不良妊娠发生率,保障母婴预后。

Objective To investigate the expressions of 25-hydroxyvitamin D[25(OH)D],irisin and bone mineral density(BMD)during pregnancy and postpartum in patients with subclinical hypothyroidism during pregnancy and their clinical relevance.Methods A total of 160 pregnant women with subclinical hypothyroidism were admitted to our hospital from June,2020 to January,2022 were included in this study.In addition,healthy pregnant women who were received physical examination in our hospital during the same period were selected as the control group.Levels of 25(OH)D_(3),irisin and bone mineral density(BMD)at the second trimester and 6 weeks after delivery were detected.The incidence of adverse pregnancy outcomes was recorded.The expressions of thyroid stimulating hormone(TSH),25(OH)D_(3),irisin and BMD were compared between the control group and the study group during pregnancy and 6 weeks after delivery.The expressions of 25(OH)D_(3),irisin,BMD and TSH in different pregnancy outcomes were compared.The correlation of pregnancy outcomes with 25(OH)D_(3),irisin,BMD and TSH was analyzed.The correlation between 25(OH)D3,irisin,BMD and TSH was analyzed.Results 25(OH)D_(3) and BMD in the study group were significantly lower than those in the control group,and irisin was significantly higher than that in the control group(all P<0.05).The incidence of adverse pregnancy in the control group was 6.88%(11/160),which was significantly lower than 25.63%(41/160)in the study group(P<0.05).25(OH)D_(3) and BMD of the poor pregnancy group were significantly lower than those of the good pregnancy group,while irisin was significantly higher than that of the good pregnancy group(all P<0.05).25(OH)D_(3) and BMD were significantly positively correlated with pregnancy outcome,while irisin and TSH were significantly negatively correlated with pregnancy outcome(all P<0.05).At 6 weeks postpartum,there was no significant difference in 25(OH)D_(3) between control group and study group(P>0.05).Irisin in the control group was significantly lower than that in the study group,while BMD was significantly higher than that in the control group(all P<0.05).Pearson analysis showed that TSH was negatively correlated with 25(OH)D_(3) and BMD,while positively correlated with irisin(all P<0.05).Conclusion In patients with subclinical hypothyroidism during pregnancy,irisin and bone metabolism are abnormal in the second trimester and 6 weeks postpartum,and are significantly correlated with pregnancy outcomes.Appropriate clinical interventions for subclinical hypothyroidism should be administered to reduce the incidence of adverse pregnancy and ensure maternal and infant prognosis.