甲状腺功能减退孕妇糖代谢、肾功能指标的变化及临床意义

目的:探究妊娠期甲状腺功能减退患者糖代谢及肾功能变化及临床意义。方法:选择2015年6月至2019年8月来我院就诊的甲状腺功能减退孕妇60例作为甲减组及同期健康孕妇60例作为对照组。比较两组患者甲状腺功能[促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT_3)及游离甲状腺素(FT_4)]、糖代谢指标[空腹血糖水平(FBG)、糖化血红蛋白(HbA1C)、餐后2 h抽取肘静脉血测定餐后2 h葡萄糖水平(2hPG)、胰岛素抵抗指标(HOMA-IR)]及肾功能[血清肌酐(Cr)、血清尿酸(UA)、血尿素氮(BUN)],分析甲状腺功能与糖代谢及肾功能的关系,比较两组患者的妊娠结局。结果:甲减组孕妇的TSH、糖代谢、肾功能各指标水平较对照组显著升高,FT_4较对照组明显降低(P0.05)。TSH与糖代谢各指标均呈正相关(P0.05);FT_4与糖代谢各指标均呈负相关(P0.05),FT_3与Cr呈负相关(P0.05),TSH、FT_4与Cr、UA、BUN均无明显相关性(P0.05)。甲减组的不良妊娠结局率为20.00%,显著高于对照组(6.67%,P0.05)。结论:妊娠期甲状腺功能减退患者存在糖代谢紊乱、肾功能异常,可能导致不良妊娠结局。

Changes and Significances of Glucose Metabolism and Renal Function Index in Pregnant Women with Hypothyroidism

ABSTRACT Objective: To explore the changes of glucose metabolism and renal function in patients with gestational hypothyroidism and their clinical significance. Methods: A total of 60 pregnant women with hypothyroidism who visited our hospital from June 2015 to August 2019 were selected as the hypothyroidism group and 60 healthy pregnant women in the same period were selected as the control group. The thyroid function [thyroid-stimulating hormone (TSH), three free iodine thyroid former glycine (FT₃) and free thyroxine (FT₄)], glucose metabolism index [(FBG), fasting blood glucose level, glycosylated hemoglobin (HbA1C), 2 h postprandial extract elbow venous blood determination of postprandial glucose level 2 h (2 HPG), insulin resistance index (HOMA IR)] and renal function (serum creatinine (Cr), serum uric acid (UA), blood urea nitrogen (BUN)] as well as the pregnancy outcome were compared between two groups of patients and the relationship between thyroid function and metabolism of glucose metabolism and renal function was analyzed. Results: The levels of TSH, glucose metabolism and renal function of pregnant women in the hypothyroidism group were significantly higher than those in the control group, and FT₄ was significantly lower than those in the control group (P<0.05). TSH was positively correlated with each index of glucose metabolism(P< 0.05). FT₄ was negatively correlated with all indicators of glucose metabolism (P< 0.05), FT₃ was negatively correlated with Cr (P<0.05), and TSH, FT₄ were not significantly correlated with Cr, UA, and BUN (P>0.05). The adverse pregnancy outcome rate of hypothyroidism group was 20.00%, significantly higher than that of control group (6.67%, P<0.05). Conclusion: Patients with hypothyroidism during pregnancy have disorders of glucose metabolism and abnormal renal function, which may lead to adverse pregnancy outcomes.