摘要
目的探讨妊娠晚期甲状腺激素水平变化与孕妇血压、血糖、血脂水平的相关性及对母婴结局的影响。方法选择2016年6月至2018年2月间温岭市第四人民医院收治的173例甲状腺功能异常孕妇为研究对象,按照游离三碘甲状腺原氨酸(FT3)、游离甲状腺原氨酸(FT4)及促甲状腺激素水平分为甲减组(n=35)、甲亢组(n=33)、亚临床甲亢组(n=35)、亚临床甲减组(n=31),单纯低甲状腺激素血症组(n=39),同期甲状腺功能正常孕妇55例为对照组。检测各组孕妇血压、血糖(空腹血糖,餐后1h、2h血糖)、血脂[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)],统计分析不良母婴结局发生率。结果在血压方面:甲亢组收缩压和舒张压均极显著高于对照组(t值分别为-15.625、-16.675,均P<0.01),甲减组收缩压和舒张压均极显著高于对照组(t值分别为-12.917、-11.998,均P<0.01),亚临床甲亢组收缩压和舒张压均极显著高于对照组(t值分别为-6.494,-3.798,均P<0.01)。血糖方面:除亚临床甲亢组和单纯低甲状腺激素血症组外,甲亢组、甲减组和亚临床甲减组空腹血糖与对照组比较差异均有统计学意义(t值分别为-2.837、-5.753、-3.550,均P<0.01);餐后1h甲减组和亚临床甲减组血糖与对照组比较差异均有统计学意义(t值分别为-16.480、-9.840,均P<0.01);餐后2h甲减组和亚临床甲减组血糖与对照组比较差异均有统计学意义(t值分别为-3.419、-2.004,均P<0.05)。血脂方面:甲状腺功能异常各组孕妇外周血TC、LDL-C与对照组比较差异均有统计学意义(t=-14.172^-2.018,均P<0.05),TG仅甲减组与对照组差异有统计学意义(t=-3.470,P<0.01),HDL-C甲减组和亚临床甲减组与对照组差异均有统计学意义(t值分别为5.500,2.807,均P<0.01)。不良母婴结局:与对照组相比,甲亢组、甲减组、亚临床甲亢组、亚临床甲减组及单纯低甲状腺激素血症组的孕妇不良妊娠结局发生率均有不同程度升高,但差异均无统计学意义(均P>0.05);甲减组新生儿不良母婴结局发生率与对照组比较差异均有统计学意义(χ~2=9.672,P<0.05),而亚临床甲亢组、亚临床甲减组及单纯低甲状腺激素血症组新生儿不良母婴结局发生率与对照组比较差异均无统计学意义(均P>0.05)。结论妊娠晚期甲状腺激素水平异常可引发孕妇血压、血糖及血脂代谢紊乱,增加不良母婴妊娠结局的发生率。
Objective To investigate the correlation between serum thyroid hormone levels and blood pressure,blood glucose and blood lipid levels as well as the influence on maternal and fetal outcomes.Methods Totally 173 cases of pregnant women with thyroid dysfunction admitted in Wenling No.4 People’s Hospital from June 2016 to February 2018 were divided into hypothyroidism group(n=35),hyperthyroidism group(n=33),subclinical hyperthyroidism group(n=35),subclinical hypothyroidism group(n=31),simple hypothyroidism group(n=39)according to free triiodothyronine(FT3)and free thyroxine(FT4).Fifty-five cases with normal thyroid function were set in control group.The blood pressure,blood glucose(fasting blood glucose,1 h,2 h blood glucose)and blood lipids(TC,TG,HDL-C and LDL-C)were measured,and the incidence of adverse maternal and infant outcomes were recorded in each group.Results In terms of blood pressure,systolic blood pressure and diastolic blood pressure were significantly higher in the hyperthyroidism group than in the control group(t value was-15.625 and-16.675,respectively,both P<0.01).The systolic and diastolic blood pressures in the hypothyroidism group were significantly higher than those in the control group(t value was-12.917 and-11.998,respectively,both P<0.01),and those in the subclinical hyperthyroidism group were significantly higher than those in the control group(t value was-6.494 and-3.798,respectively,both P<0.01).In terms of blood glucose,the fasting blood glucose levels of all the groups except the simple hypothyroidism group and the subclinical hyperthyroidism group were significantly different from the control group(t value was-2.837,-5.753 and-3.55,respectively,all P<0.01).Blood glucose 1 h after meal of hypothyroidism group and subclinical hypothyroidism group was significantly different from that of the control group(t value was-16.48 and-9.840,respectively,both P<0.01).There was significant difference in the blood glucose 2 h after meal between hypothyroidism group and the subclinical hypothyroidism group and the control group(t value was-3.419 and-2.004,respectively,both P<0.05).The levels of TC and LDL-C of the groups with thyroid dysfunction in the peripheral blood were significantly different from those of the control group(t value ranged-14.172 to-2.018,P<0.01),while TG level was significantly different between the hypothyroidism group and the control group(t=-3.47,P<0.01).HDL-C was significantly different between the hypothyroidism group and the subclinical hypothyroidism group and the control group(t value was 5.500 and 2.807,respectively,both P<0.01).When compared with the control group,the incidence of poor maternal outcomes increased to different extend in hyperthyroidism group,hypothyroidism group,subclinical hyperthyroidism group,subclinical hypothyroidism group and simple hypothyroidism group,but the difference was not significant(all P>0.05).The incidence of maternal and neonatal adverse pregnancy outcomes in the hypothyroidism group was significantly different from that in the control group(χ~2=9.672,P<0.05),but that in the subclinical hypothyroidism group,the subclinical hyperthyroidism group and simple hypothyroidism group was not different with statistical significance(both P>0.05).Conclusion Abnormal thyroid hormone levels may lead to disorder of blood pressure,blood glucose and lipid metabolism in pregnant women in the third trimester,which increases the incidence of adverse maternal and neonatal outcomes.
作者
陈希超
徐正芬
CHEN Xichao;XU Zhengfen(Wenling No.4 People’s Hospital,Zhejiang Wenling 317511,China)
出处
《中国妇幼健康研究》
2019年第6期736-741,共6页
Chinese Journal of Woman and Child Health Research
关键词
甲状腺激素水平异常
血压
血糖
血脂
母婴结局
abnormal thyroid hormone levels
blood pressure
blood glucose
blood lipids
maternal and neonatal outcomes
