妊娠期甲状腺疾病与妊娠期糖尿病的关联研究

发布时间：2018-01-05 18:16

本文关键词：妊娠期甲状腺疾病与妊娠期糖尿病的关联研究　出处：《上海交通大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:1.评估妊娠早期甲状腺疾病与妊娠期糖尿病(GDM)的发生是否具有关联性;2.分析妊娠期甲状腺功能异常与GDM合并存在是否可对妊娠结局造成较多不良影响。方法:1.依照纳入及排除标准收集本院9705例孕妇为研究对象,检测其妊娠早期甲状腺功能指标并分组(临床甲减组、亚临床甲减组、临床甲亢组、亚临床甲亢组、低甲状腺素血症组和单纯TPOAb阳性组)。GDM的诊断采用口服葡萄糖耐量试验,并收集三点血糖值。统计分析甲状腺功能指标与血糖指标间是否存在线性依存关系及妊娠早期各种甲状腺疾病是否增加GDM的发生风险。2.研究对象的入选方法同上。采用零膨胀泊松回归模型和多元logistic回归模型来分析TSH、FT4及TPOAb水平异常且分别合并GDM时与巨大儿、胎儿窘迫、妊娠期高血压疾病、羊水污染、胎膜早破和早产的发生是否具有相关性。结果:1.低甲状腺素血症组三点血糖值均比甲状腺功能正常组高(t=-4.54,P㩳0.001;t=-6.96,P㩳0.001;t=-5.82,P㩳0.001);2.各组甲状腺疾病中仅低甲状腺素血症组(16.73%)GDM的发病率较甲状腺功能正常组(9.57%)高(χ2=32.10,P㩳0.001);3.多元线性回归发现FT4水平与三点血糖值均呈负相关;4.在调整孕妇年龄和BMI后,低甲状腺素血症组仍可增加GDM 49%的发生率(OR 1.49,95%CI 1.19-1.87);FT4水平从1pmol/L升高到45pmol/L时,GDM的发生率从26.48%下降到0.71%(P=0.002);5.单纯TPOAb阳性合并GDM分娩巨大儿的可能性增高(t=2.29,P=0.022);6.当低FT4水平合并GDM以及单纯TPOAb阳性合并GDM时与早产的发生呈正相关(t=3.26,P=0.001;t=2.66,P=0.008);7.单纯TPOAb阳性合并GDM可增加胎膜早破1.09倍(OR 2.09,95%CI1.19-3.67)的发生风险。结论:1.妊娠早期低甲状腺素血症是GDM发生的危险因素,FT4是GDM的保护因素;2.单纯TPOAb阳性合并GDM时,分娩巨大儿的可能性增高;3.低FT4水平合并GDM及单纯TPOAb阳性合并GDM与早产的发生呈正相关;4.单纯TPOAb阳性合并GDM可增加胎膜早破1.09倍的发生风险。
[Abstract]:Objective: To evaluate 1. early pregnancy thyroid disease and gestational diabetes mellitus (GDM) is the relevance of the 2. generation; analysis of gestational thyroid dysfunction and GDM and whether there can be adverse effects more on pregnancy outcome. Methods: 1. in accordance with inclusion and exclusion criteria used in our hospital 9705 cases of pregnant women as the research object, its detection early pregnancy thyroid function index and group (clinical hypothyroidism group, subclinical hypothyroidism group, clinical hyperthyroidism group, subclinical hyperthyroidism group and hypothyroxinemia group and TPOAb positive group) in the diagnosis of.GDM by oral glucose tolerance test, and collected three blood glucose values. Statistical analysis of the existence of linear dependency relation and early pregnancy all kinds of thyroid disease whether to increase the occurrence of GDM of.2. was selected. Risk function index and glycemic index of thyroid. Using zero inflated Poisson regression model and multiple Logistic regression analysis of TSH, FT4 and TPOAb respectively and the abnormal level with GDM and macrosomia, fetal distress, hypertension, pregnancy, amniotic fluid pollution, whether there is correlation between premature rupture of membranes and preterm birth. Results: 1. hypothyroxinemia group of three blood glucose values were higher than normal thyroid function group (t=-4.54. P? 0.001; t=-6.96, 0.001; P? T=-5.82, P? 0.001); 2. were thyroid disease only in hypothyroxinemia group (16.73%) the incidence of GDM compared with normal thyroid function group (9.57%) and high (x 2=32.10, P? 0.001); 3. multivariate linear regression found that FT4 levels and blood glucose values three in 4. were negatively correlated; adjustment of maternal age and BMI, hypothyroxinemia group can increase the incidence rate of GDM 49% (OR 1.49,95%CI 1.19-1.87); the level of FT4 increased from 1pmol/L to 45pmol/L, the incidence rate of GDM decreased from 26.48% to 0.71% (P=0.002); 5. with positive TPOAb The possibility of increased with GDM fetal macrosomia (t=2.29, P=0.022); 6. when the lower level of FT4 and GDM and simple TPOAb positive with GDM and preterm birth was positively correlated (t=3.26, P=0.001; t=2.66, P=0.008; 7.) with positive TPOAb combined with GDM can increase the prom 1.09 times (OR 2.09,95%CI1.19-3.67) risk 1.. Conclusion: early pregnancy hypothyroxinemic are risk factors of GDM, FT4 is a protective factor for GDM; 2. with positive TPOAb with GDM, the possibility of increased fetal macrosomia; 3. was positively correlated with low levels of FT4 combined with GDM and TPOAb alone with positive GDM and preterm birth related risk; 4. only with positive TPOAb GDM can increase the prom 1.09 times.

【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R714.256

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