甲状腺功能减退对妊娠期糖尿病患者糖脂代谢、心功能及妊娠结局的影响

目的探讨甲状腺功能减退对妊娠期糖尿病患者糖脂代谢、心功能及妊娠结局的影响。方法选取2016年1月-2018年8月于江山市妇幼保健院内科就诊的甲状腺功能减退合并妊娠期糖尿病患者82例作为研究组,另选取同期于本院就诊的甲状腺功能正常的妊娠期糖尿病患者80例作为对照组。比较两组孕妇甲状腺激素水平、孕妇空腹血糖(FBG)、口服75 g葡萄糖后的2 h血糖(PBG 2h)、血脂水平和脉冲多普勒超声心动图指标以及妊娠结局情况。结果研究组孕妇血清促甲状激素(TSH)水平显著高于对照组,游离甲状腺素(FT4)、游离三碘甲状原氨酸(FT3)水平显著低于对照组孕妇,差异均有统计学意义(P<0. 05)。研究组孕妇FBG、PBG 2h、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平显著高于对照组,高密度脂蛋白胆固醇(HDL-C)水平显著低于对照组孕妇,差异均有统计学意义(P<0. 05)。研究组孕妇二尖瓣口、三尖瓣口E峰显著低于对照组,A峰显著高于对照组,LVEF显著低于对照组孕妇,差异均有统计学意义(P<0. 05)。研究组孕妇前置胎盘、胎盘早剥、胎膜早破、产后出血发生率显著高于对照组孕妇,差异均有统计学意义(P<0. 05),两组剖宫产率比较差异无统计学意义(P>0. 05)。研究组胎儿生长受限、低出生体质量儿、新生儿窒息、早产发生率显著高于对照组孕妇,差异有统计学意义(P<0. 05)。结论甲状腺功能减退会加重妊娠期糖尿病患者糖脂代谢异常,进而导致孕妇血糖、血脂代谢紊乱,心脏射血功能降低,并且孕妇不良妊娠发生率显著升高。

Effect of hypothyroidism on glycolipid metabolism,cardiac function,and pregnancy outcome in patients with gestational diabetes mellitus

Objective To explore the effect of hypothyroidism on glycolipid metabolism,cardiac function,and pregnancy outcome in patients with gestational diabetes mellitus( GDM). Methods From January 2016 to August 2018,82 GDM patients with hypothyroidism treated in Department of Internal Medicine,Jiangshan Maternal and Child Health Care Hospital were selected as study group,80 GDM patients with normal thyroid function were selected as control group. The levels of thyroid hormone,fasting blood glucose( FBG),2-hour postprandial blood glucose( PBG 2 h),blood lipids,pulsed Doppler echocardiography indexes,and pregnancy outcomes were compared between the two groups. Results The level of serum thyroid-stimulating hormone( TSH) in study group was significantly higher than that in control group;the levels of free thyroxine( FT4) and free triiodothyronine( FT3) were significantly lower than those in control group( P<0. 05).The levels of FBG,PBG 2 h,triglyceride( TG),total cholesterol( TC),low-density lipoprotein cholesterol( LDL-C) in study group were significantly higher than those in control group;the level of high-density lipoprotein cholesterol( HDL-C) was significantly lower than that in control group( P<0. 05). The E peaks of mitral and tricuspid orifices in study group were significantly lower than those in control group,A peak was significantly higher than that in control group,LVEF was significantly lower than that in control group( P<0. 05). The incidence rates of placenta previa,placental abruption,premature rupture of membranes,and postpartum hemorrhage in study group were significantly higher than those in control group( P<0. 05),there was no significant difference in cesarean section rate between the two groups( P>0. 05). The incidence rates of fetal growth restriction,low birth weight,neonatal asphyxia,and premature delivery in study group were significantly higher than those in control group( P<0. 05). Conclusion Hypothyroidism can aggravate abnormal glucose and lipid metabolism in GDM patients,which leads to the disorder of blood glucose and lipid metabolism,decrease of cardiac ejection function,and increase of incidence rate of adverse pregnancy outcome.