妊娠早期甲状腺血清指标与妊娠期糖尿病的关系

The Relationship between Thyroid Serum Indexes in Early Pregnancy and Diabetes in Pregnancy

摘要: 目的：评估妊娠早期甲状腺功能与妊娠期糖尿病(Gestational diabetes mellitus, GDM)发生的关系。方法：本研究为回顾性研究。研究对象为206例GDM患者，另招募125例糖耐量正常的妊娠孕妇做为对照组。均为在呼和浩特地区居住1年以上且此次妊娠为单胎的妊娠孕妇。两组受试者均在妊娠早期采血检测，比较空腹血糖、促甲状腺激素(TSH)、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)和FT3:FT4比值。采用ROC曲线分析TSH、FT4和FT3作为GDM指标和诊断预测因素的敏感性和特异性。结果：与对照组相比，GDM患者TSH和FT3浓度明显较高，FT4的浓度较低，FT3:FT4比值较高(所有P < 0.05)。TSH临界浓度 ≥ 2.532 mUI/L可以预测GDM，敏感性为43.7%，特异性为89.4%。FT3的临界浓度 ≥ 4.873 pg/mL可以预测GDM，敏感性为44.6%，特异性为86.4%。FT4的临界浓度 ≥ 3.203 ng/dL可以排除GDM，敏感性为53.4%，特异性为61.9%。结论：结果表明，妊娠早期高TSH浓度和FT3浓度可能表明GDM发生的风险增加。

Abstract: Objective: To evaluate the relationship between thyroid function in early pregnancy and Gestational diabetes (GDM). Methods: This study was a retrospective study. The research subjects were 206 patients with GDM, and 125 pregnant women with normal glucose tolerance were recruited as the control group. All of them were pregnant women who had lived in Hohhot for more than one year and this pregnancy was a singleton pregnancy. Both groups of subjects were tested for fasting blood glucose, thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), and FT3: FT4 ratio during early pregnancy. ROC curve analysis was used to evaluate the sensitivity and specificity of TSH, FT4, and FT3 as GDM indicators and diagnostic predictive factors. Results: Compared with the control group, GDM patients had significantly higher TSH and FT3 concentrations, lower FT4 concentrations, and a higher FT3:FT4 ratio (all P < 0.05). The critical concentration of TSH ≥ 2.532 mUI/L can predict GDM, with a sensitivity of 43.7% and specificity of 89.4%. The critical concentration of FT3 ≥ 4.873 pg/mL can predict GDM, with a sensitivity of 44.6% and specificity of 86.4%. The critical concentration of FT4 ≥ 3.203 ng/dL could exclude GDM, with a sensitivity of 53.4% and specificity of 61.9%. Conclusion: The results indicated that high TSH and FT3 concentrations in early pregnancy might indicate an increased risk of GDM.