甲状腺功能减退症孕妇血浆脂质代谢特征及与妊娠结局的关联

Plasma lipid metabolism characteristics of pregnant women with hypothyroidism and their association with pregnancy outcomes

目的探讨合并甲状腺功能减退症(简称甲减)的孕妇血浆脂质代谢特征与妊娠结局的关联。方法选取2022年1月至2024年1月在陕西中医药大学第二附属医院就诊的孕晚期合并甲减孕妇114例作为观察组,年龄(30.41±4.22)岁,同时选取健康孕晚期孕妇114例作为对照组,年龄(29.73±5.06)岁。比较两组及观察组不同妊娠结局产妇甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、磷脂酰胆碱(PC)、溶血磷脂酰胆碱(LPC)和磷脂酰乙醇胺(PE)等指标差异。组间比较采用独立样本t检验,血脂指标与血清促甲状腺激素(TSH)、总三碘甲状腺原氨酸(FT3)、总甲状腺素(FT4)的相关性采用Pearson相关分析,受试者操作特征曲线(ROC)分析PC、LPC和PE预测不良妊娠结局的价值。结果观察组TG、TC、LDL-C、PC、LPC、PE、TSH水平均高于对照组[(4.58±1.01)mmol/L比(2.66±0.72)mmol/L、(6.72±1.03)mmol/L比(4.89±1.11)mmol/L、(3.92±1.00)mmol/L比(2.62±0.68)mmol/L、(382.45±36.66)ng/L比(334.20±41.18)ng/L、(16.40±1.81)μg/L比(14.22±1.95)ng/L,(17.40±1.81)μg/L比(14.05±1.68)ng/L,(5.12±0.77)uIU/L比(1.26±0.22)uIU/L,均P<0.05],FT3、FT4均低于对照组[(3.81±0.72)pmol/L比(4.50±0.68)pmol/L、(6.00±0.81)pmol/L比(10.44±0.77)pmol/L,均P<0.05]。PC、LPC、PE与TSH呈正相关(r=0.472、0.453、0.552,均P<0.05),与FT3、FT4呈负相关(r=-0.322、-0.341、-0.399、-0.336、-0.314、-0.417,均P<0.05)。观察组发生不良妊娠结局产妇PC、LPC和PE水平高于未发生不良妊娠结局产妇[(399.74±38.81)ng/L比(372.36±39.40)ng/L、(17.95±1.92)μg/L比(15.50±1.87)μg/L、(18.22±1.92)μg/L比(16.92±1.81)μg/L,均P<0.05)。PC、LPC和PE预测不良妊娠结局的曲线下面积分别为0.733、0.854和0.724,P<0.05。结论合并甲减孕妇的血脂相关指标明显升高,其中PC、LPC、PE与TSH、FT3、FT4和妊娠结局存在相关性,在预测不良妊娠结局方面有一定应用价值。

Objective To explore the characteristics of plasma lipid metabolism in pregnant women with hypothyroidism and their association with pregnancy outcomes.Methods One hundred and fourteen late pregnant patients with hypothyroidism who visited Second Hospital,Shaanxi University of Traditional Chinese Medicine from January 2022 to January 2024 were selected as an observation group;they were(30.41±4.22)years old.One hundred and fourteen normal late pregnant women during the same period were selected as a control group;they were(29.73±5.06)years old.The levels of triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),phosphatidylcholine(PC),lysophosphatidylcholine(LPC),and phosphatidylethanolamine(PE)were compared between the two groups by independent-sample t test.The correlations of the lipid indicators with thyroid stimulating hormone(TSH),triiodothyronine(FT3),and total thyroxine(FT4)were analyzed by the Pearson correlation analysis.The values of PC,LPC,and PE in the prediction of adverse pregnancy outcomes were analyzed by the receiver operating characteristic curve(ROC).Results The levels of TG,TC,LDL-C,PC,LPC,and PE of the observation group were higher than those of the control group[(4.58±1.01)mmol/L vs.(2.66±0.72)mmol/L,(6.72±1.03)mmol/L vs.(4.89±1.11)mmol/L,(3.92±1.00)mmol/L vs.(2.62±0.68)mmol/L,(382.45±36.66)ng/L vs.(334.20±41.18)ng/L,(16.40±1.81)μg/L vs.(14.22±1.95)ng/L,(17.40±1.81)μg/L vs.(14.05±1.68)ng/L,and(5.12±0.77)uIU/L vs.(1.26±0.22)uIU/L;all P<0.05];the levels of FT3 and FT4 of the observation group were lower than those of the control group[(3.81±0.72)pmol/L vs.(4.50±0.68)pmol/L and(6.00±0.81)pmol/L vs.(10.44±0.77)pmol/L;both P<0.05].PC,LPC,PE were positively correlated with TSH(r=0.472,0.453,and 0.552;all P<0.05),and negatively with FT3 and FT4(r=-0.322,-0.341,-0.399,-0.336,-0.314,and-0.417;all P<0.05).The levels of PC,LPC,and PE of the women with adverse pregnancy outcomes in the observation group were higher than those in the women without adverse pregnancy outcomes[(399.74±38.81)ng/L vs.(372.36±39.40)ng/L,(17.95±1.92)μg/L vs.(15.50±1.87)μg/L,and(18.22±1.92)μg/L vs.(16.92±1.81)μg/L;all P<0.05].The areas under the ROC's of PC,LPC,and PE for predicting adverse pregnancy outcomes were 0.733,0.854,and 0.724,respectively(all P<0.05).Conclusions Pregnant women with combined hypothyroidism have increase in blood lipid related indicators;among which,PC,LPC,and PE are correlated with the three indicators of hypothyroidism and pregnancy outcomes.At the same time,they have certain application value in predicting adverse pregnancy outcomes.