孕妇甲状腺疾病和GDM的关联及其对妊娠结局的影响与干预

发布时间：2018-11-29 13:05

【摘要】：目的甲状腺疾病在生育期年龄妇女中极其常见，，而妊娠糖尿病（GDM）近年随着生活水平的提高也呈现升高趋势。鉴于妊娠可对机体整个内分泌系统带来影响，本文旨在观察这两种产科常见内分泌疾病之间的关系、对妊娠结局的影响以及干预治疗的效果。方法研究对象来自2012年2月-2013年11月间于上海第一人民医院产科进行产检并分娩的孕妇，在孕中期开始进行甲状腺激素及抗体和GDM筛查，观察甲状腺疾病和GDM的患病率及二者之间的关系；妊娠期甲状腺激素水平的动态变化；孕妇合并甲状腺疾病对妊娠并发症及新生儿的影响；合并甲状腺疾病的孕妇给予左旋甲状腺素（L-T4）干预治疗能否改善妊娠结局。结果本研究共入组2113例孕妇，其中既往无甲状腺疾病及糖尿病等相关病史的孕妇1974例。经本次筛查发现甲状腺疾病总患病率37.84%，其中以亚临床甲状腺功能减退最常见，为19.55%，其次为甲状腺功能正常TPOAb阳性。患有GDM孕妇出现甲状腺疾病者较无GDM的孕妇高（47.35%比36.37%，P=0.001）。在既无甲状腺疾病也无GDM的正常孕妇中，妊娠期血清甲状腺激素水平在正常范围内有所波动，血清TSH水平呈上升趋势，血清FT3、FT4水平呈下降趋势。合并甲状腺疾病的孕妇出现GDM、胎膜早破、胎儿生长受限、早产等的概率较正常组的孕妇高，差异具有统计学意义（P0.05）。其中亚临床甲减、临床甲减、TPOAb阳性的孕妇出现产科并发症的风险较大，通过L-T4干预治疗，可减少产科并发症的发生，药物干预可以改善血清TSH水平，但是对血清FT3、FT4水平影响无明显。结论本研究提示不少“正常”孕妇在妊娠期可检出甲状腺疾病和GDM，在GDM孕妇中妊娠甲状腺疾病的患病率明显升高。正常孕妇妊娠期血清甲状腺激素水平可在正常范围内波动。孕妇甲状腺功能异常可增加产科并发症的发生率，对新生儿产生不利的影响，积极的药物干预可改善妊娠结局。
[Abstract]:Objective thyroid disease is very common in women of reproductive age, and (GDM) of gestational diabetes mellitus (PDM) has been increasing with the improvement of living standard in recent years. In view of the effect of pregnancy on the whole endocrine system, the purpose of this paper is to observe the relationship between the two common endocrine diseases in obstetrics, the effect on pregnancy outcome and the effect of intervention therapy. Methods pregnant women from February 2012 to November 2013 in Shanghai first people's Hospital were screened for thyroid hormones and antibodies and GDM. The prevalence of thyroid disease and GDM and the relationship between them were observed. The dynamic changes of thyroid hormone levels during pregnancy, the influence of pregnant women with thyroid disease on pregnancy complications and newborn, and whether the pregnant women with thyroid disease can improve the outcome of pregnancy with the intervention of levothyroxine (L-T4). Results A total of 2113 pregnant women were enrolled in this study, 1974 of whom had no history of thyroid disease and diabetes mellitus. The total prevalence rate of thyroid diseases was 37.84%, among which subclinical hypothyroidism was the most common, 19.55%, followed by normal thyroid TPOAb positive. The incidence of thyroid disease in pregnant women with GDM was higher than that without GDM (47.35% vs 36.37%, P0. 001). In normal pregnant women with neither thyroid disease nor GDM, serum thyroid hormone level fluctuated within normal range, serum TSH level increased and serum FT3,FT4 level decreased. The probability of premature rupture of GDM, membranes, fetal growth restriction and premature delivery in pregnant women with thyroid disease was higher than that in normal pregnant women (P0.05). Pregnant women with subclinical hypothyroidism and TPOAb positive had a higher risk of obstetric complications. Intervention with L-T4 could reduce the incidence of obstetric complications. Drug intervention could improve serum TSH level, but it could improve serum FT3,. There was no significant effect on FT4 level. Conclusion this study suggests that many "normal" pregnant women can detect thyroid diseases during pregnancy and the prevalence of GDM, in pregnant women with GDM is significantly higher. Serum thyroid hormone levels in normal pregnant women can fluctuate within normal range. Abnormal thyroid function of pregnant women can increase the incidence of obstetric complications and have adverse effects on the newborn. Active drug intervention can improve the outcome of pregnancy.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.256

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