Hcy、维生素B12及叶酸在妊娠期亚临床甲状腺功能减退中的水平变化及临床意义

The changes of Hcy,vitamin B12 and folic acid in Subclinical Hypothyroidism(SCH)during pregnancy and its clinical significance

目的 探究同型半胱氨酸(Hcy)、维生素B12及叶酸在妊娠期亚临床甲状腺功能减退(SCH)中的水平变化和临床意义。方法 选取2021年7月至2023年2月成都市第五人民医院收治的58例SCH患者为观察组,另选取同期53名甲状腺功能正常的妊娠期女性为对照组。比较两组Hcy、维生素B12、叶酸水平和甲状腺功能[促甲状腺激素(TSH)、血清游离三碘甲状原氨酸(FT3)、血清游离甲状腺素(FT4)水平],使用Spearma相关性分析Hcy、维生素B12、叶酸与甲状腺功能减退之间的关系,使用ROC曲线分析Hcy、维生素B12、叶酸单独及联合检测SCH的诊断效能。结果 观察组Hcy、TSH水平比对照组高,维生素B12、叶酸水平比对照组低,差异具有统计学意义(P<0.05);两组FT3、FT4水平比较,差异无统计学意义(P>0.05);经Spearman相关性分析显示:Hcy与TSH水平呈正相关(r=0.536,P<0.05),与FT3、FT4、叶酸、维生素B12均呈负相关(r=-0.622、-0.517、-0.662、-0.574,P值均<0.05);叶酸与维生素B12呈正相关(r=0.632,P<0.05),与Hcy呈负相关(r=0.704,P<0.05),与FT3、FT4、TSH无相关性(P值均>0.05);维生素B12与FT3、FT4水平呈正相关(r=0.624、0.528,P值均<0.05),与TSH、Hcy呈负相关(r=-0.643、-0.527,P值均<0.05),与叶酸无相关性(P>0.05);ROC曲线显示,Hcy、维生素B12、叶酸检测诊断SCH的AUC值分别为0.766、0.631、0.723,三者联合诊断AUC值为0.901、灵敏度为0.879、特异度为0.902、95%CI为0.833~0.967,联合检测诊断效能高于三指标单独检测(P<0.05)。结论 妊娠期亚临床甲状腺功能减退患者Hcy、维生素B12、叶酸水平存在异常,检测上述指标水平可为临床评估、诊断病情提供依据。

Objective To investigate the changes of homocysteine(Hcy)and vitamin B12 and fo-lic acid in subclinical hypothyroidism(SCH)during pregnancy and its clinical significance.Methods 58 SCH patients admitted to Chengdu Fifth Peoples Hospital from July 2021 to February 2023 were selected as the ob-servation group,while another 53 pregnant women with normal thyroid function were selected as the control group.The levels of Hcy,vitamin B12 and TSH were compared between the two groups.Risk factors affecting SCH were analyzed using multiple logistic regression and the relationship between Hcy,vitamin B12,folate levels and thyroid function[thyroid stimulating hormone(TSH),serum free triiodothyronine(FT3),free thy-roxine(FT4)levels]between the two groups were compared.Spearman correlation was used to analyze the rela-tionship between Hcy,vitamin B12 and folic acid and hypothyroidism.The ROC curve was used to analyze the diagnostic efficiency of Hcy,vitamin B12,TSH alone and combined detection of SCH.Results The levels of Hcy and TSH in the observation group were higher than those in the control group,and the levels of vitamin B12 and folic acid were lower than those in the control group,with statistically significant differences(P<0.05).The comparison of the levels of FT3 and FT4 between the two groups did not show any statistically significant dif-ferences (P>0.05).Spearman correlation analysis showed that Hcy was positively correlated with TSH levels(r=0.536,P<0.05),and was negatively correlated with FT3,FT4,folate and vitamin B12 levels(r=-0.622,-0.517,-0.662,-0.574,P<0.05).TSH levels were positively correlated with FT3,FT4 and Hcy levels(r=0.682,0.575,0.567),and P<0.05,but had no correlation with folic acid and vitamin B12(P>0.05).Vitamin B12 levels were positively correlated with FT3 and FT4 levels(r=0.624,0.528,P<0.05),and negatively corre-lated with TSH and Hcy(r=-0.643,-0.527,P<0.05),but had no correlation with folate(P>0.05).The ROC curve showed that the AUC value of Hcy,vitamin B12 and folic acid for the diagnosis of SCH was 0.766,0.631 and 0.723,respectively.The AUC value of the combined diagnosis of HCY,vitamin B12 and folic acid was 0.901,with a sensitivity of0.879,specificity of of 0.902,and a 95%CI of 0.833-0.967.The diagnostic efficiency of the combined detection was higher than that of the three indicators alone(P<0.05).Conclusion Patients with subclinical hypothyroidism during pregnancy may have abnormal levels of Hcy,vitamin B12,and folate.Detecting the levels of these indicators can serve as a basis for clinical evaluation and diagnosis of the condition.