妊娠期糖尿病合并亚临床甲状腺功能减退症孕妇的血脂水平研究

张莉，张立芹，时志国

【摘要】目的分析妊娠期糖尿病（GDM）合并亞临床甲状腺功能减退症（SCH）孕妇的血脂水平，并比较孕中晚期患者体内血脂代谢情况。方法收集2015年9月13日至2019年5月31日在北京市延庆区妇幼保健院建档且进行规律产前检查28周以上的孕妇419例，根据口服葡萄糖耐量试验（OGTT）筛查及甲状腺功能情况分为GDM组132例，SCH组83例，GDM+SCH组49例，选择同期建档的正常健康孕妇155例为对照组。对纳入研究的孕妇在孕中期和孕晚期分别测定其血糖（GLU）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）。测定外周血标本前需进行仪器的维护、校准和质控，所有标本采集后需4 h内完成检测。结果经方差分析和组间q检验发现，GDM+SCH组除HDL-C外，TC、TG、LDL-C、GLU水平与SCH组、GDM组和对照组同期比较，差异有统计学意义（P<0.05）。SCH组在不同孕周与对照组比较，差异均无统计学意义（P>0.05）。GDM组在不同孕周与对照组比较，差异均有统计学意义（P<0.05）。结论GDM合并SCH对孕妇的糖脂代谢除HDL-C外，有显著影响，并随着孕周的增长脂代谢紊乱明显，需早期合理干预，改善不良妊娠结局。

【关键词】妊娠期糖尿病;亚临床甲状腺功能减退症;血脂

中图分类号：R714.256文献标志码：ADOI：10.3969/j.issn.1003-1383.2021.11.009

Study on blood lipid levels in pregnant women with gestational

diabetes mellitus and subclinical hypothyroidism

ZHANG Li， ZHANG Liqin， SHI Zhiguo

（Department of Laboratory Medicine， Maternal and Child Health Hospital of Yanqing District， Beijing 102100， China）

【Abstract】ObjectiveTo analyze blood lipid levels in pregnant women with gestational diabetes mellitus （GDM） and subclinical hypothyroidism （SCH）， and to compare the blood lipid metabolism of patients in middle and late pregnancy. Methods419 pregnant women who had filed in Maternal and Child Health Hospital of Yanqing District and underwent regular prenatal check-ups for more than 28 weeks from September 13， 2015 to May 31， 2019 were collected. According to oral glucose tolerance test （OGTT） screening and thyroid function， 132 patients were included in GDM group， 83 in SCH group， and 49 in GDM + SCH group， and 155 normal healthy pregnant women registered during the same period were selected as control group. For pregnant women included in the study， their blood glucose （GLU）， total cholesterol （TC）， triacylglycerol （TG）， high density lipoprotein cholesterol （HDL-C） and low density lipoprotein cholesterol （LDL-C） were measured in the middle and late pregnancy， respectively. Instrument maintenance， calibration and quality control should be carried out before measuring peripheral blood samples， and all samples should be tested within 4 hours after collection. ResultsThe analysis of variance and the between-group q-test found that， except for HDL-C， there were statistically significant differences of the levels of TC， TG， LDL-C， and GLU in the GDM+SCH group， the SCH group， the GDM group and the control group （P < 0.05）. There was no statistically significant difference between the SCH group and the control group at different gestational weeks （P > 0.05）， while there was statistically significant difference between the GDM group and the control group at different gestational weeks （P < 0.05）. ConclusionGDM combined with SCH has a significant effect on the glucose and lipid metabolism of pregnant women. As the gestational age increases， lipid metabolism disorder is obvious， so early and reasonable interventions are needed to improve adverse pregnancy outcomes.

【Key words】GDM; SCH; blood lipid

妊娠期亚临床甲状腺功能减退症（subclinical hypothyroidism，SCH）是妊娠期常见的甲状腺功能异常，是指孕妇血清促甲状腺激素（TSH）水平高于妊娠期特异的参考值上限，且游离甲状腺素（FT4）水平在妊娠期特异的参考值范围内。2015年美国妇产科医师协会（ACOG）发布的《妊娠期甲状腺疾病临床指南》指出，SCH在妊娠期妇女中的发生率为2%～5%。……