摘要
目的 探讨妊娠期糖尿病(GDM)合并亚临床型甲状腺功能减退症(SCH)孕妇血清25-羟基维生素D[25(OH)D]、糖脂代谢和心功能的变化及临床意义。方法 选取2019年4月至2021年7月陕西中医大学第二附属医院收治的100例GDM合并SCH孕妇作为研究组,并选择同期收治的120例单纯GMD孕妇作为对照组。比较两组孕妇促甲状腺激素(TSH)、游离甲状腺素(FT4)、25(OH)D、空腹血糖(FPG)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平,以及二尖瓣瓣口(MV)、三尖瓣瓣口(TV)的舒张早期血流最大峰值速度(E峰)、舒张晚期血流最大峰值速度(A峰)和左室射血分数(LVEF),采用Pearson相关性分析法分析TSH与25(OH)D、糖脂代谢、心功能指标的相关性。结果 研究组孕妇的TSH为(6.94±1.56) mIU/L,明显高于对照组的(1.67±0.30) m IU/L,FT4为(14.72±2.09) pmol/L,明显低于对照组的(16.06±2.15) pmol/L,差异均有统计学意义(P<0.05);研究组孕妇的25(OH)D、HDL-C分别为(28.34±2.60) ng/mL、(1.21±0.10) mmol/L,明显低于对照组的(37.23±4.18) ng/mL、(1.35±0.14) mmol/L,FBG、TG、TC、LDL-C分别为(8.67±0.83) mmol/L、(1.73±0.22) mmol/L、(5.21±0.62) mmol/L、(3.10±0.28) mmol/L,明显高于对照组的(7.83±0.59) mmol/L、(1.35±0.19) mmol/L、(4.39±0.41) mmol/L、(2.46±0.22) mmol/L,差异均有统计学意义(P<0.05);研究组孕妇MV、TV的E峰以及LVEF分别为(73.67±10.48) cm/s、(45.63±5.18) cm/s、(55.67±5.21)%,均明显低于对照组的(8.45±13.09) cm/s、(61.29±7.61) cm/s、(61.92±7.32)%,MV、TV的A峰分别为(72.01±8.26) cm/s、(51.02±5.82) cm/s,均明显高于对照组的(61.33±6.89) cm/s、(43.15±4.66) cm/s,差异均有统计学意义(P<0.05);经Pearson相关性分析结果显示,TSH与25(OH)D、HDL-C、MV和TV的E峰、LVEF均呈负相关(P<0.05),与FBG、TG、TC、LDL-C、MV和TV的A峰均呈正相关(P<0.05)。结论 GDM合并SCH孕妇会导致患者25(OH)D降低、糖脂代谢紊乱,且会对心功能产生影响,临床上应予以密切关注。
Objective To study the changes and clinical significance of serum 25-hydroxyl vitamin D[25(OH)D],glycolipid metabolism and cardiac function in pregnant women with gestational diabetes mellitus(GDM)and subclinical hypothyroidism(SCH).Methods A total of 100 pregnant women with GDM and SCH who were admitted to the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from April 2019 to July 2021 were selected as the research group,and 120 pregnant women with simple GMD were selected as the control group.The thyroid stimulating hormone(TSH),free thyroxine(FT4),25(OH)D,fasting blood glucose(FPG),triacylglycerol(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),the maximum peak velocity of early diastolic blood flow(E peak)and late diastolic blood flow(A peak)of mitral valve orifice(MV)and tricuspid valve orifice(TV),and left ventricular ejection fraction(LVEF)were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between TSH and 25(OH)D,glucolipid metabolism,cardiac function.Results The TSH in research group was(6.94±1.56)mIU/L,which was significantly higher than(1.67±0.30)mIU/L of control group,and FT4 was(14.72±2.09)pmol/L,which was significantly lower than(16.06±2.15)pmol/L of control group,with statistically significant differences(P<0.05).The 25(OH)D and HDL-C in research group were(28.34±2.60)ng/mL and(1.21±0.10)mmol/L,which were significantly lower than(37.23±4.18)ng/mL and(1.35±0.14)mmol/L of control group;FBG,TG,TC,and LDL-C were(8.67±0.83)mmol/L,(1.73±0.22)mmol/L,(5.21±0.62)mmol/L,(3.10±0.28)mmol/L,which were significantly higher than(7.83±0.59)mmol/L,(1.35±0.19)mmol/L,(4.39±0.41)mmol/L,(2.46±0.22)mmol/L of control group,with statistically significant differences(P<0.05).E peak of MV and TV and LVEF in research group were(73.67±10.48)cm/s,(45.63±5.18)cm/s,(55.67±5.21)%,which were significantly lower than(8.45±13.09)cm/s,(61.29±7.61)cm/s,(61.92±7.32)%of control group;the A peaks of MV and TV were(72.01±8.26)cm/s and(51.02±5.82)cm/s,which were significantly higher than(61.33±6.89)cm/s and(43.15±4.66)cm/s of control group,with statistically significant differences(P<0.05).Pearson correlation analysis showed that TSH was negatively correlated with 25(OH)D,HDL-C,E peak of MV and TV,and LVEF(P<0.05),and positively correlated with FBG,TG,TC,LDL-C,A peaks of MV and TV(P<0.05).Conclusion GDM combined with SCH in pregnant women can lead to the decrease of 25(OH)D,the disorder of glucose and lipid metabolism,and affect the cardiac function,which should be paid close attention to clinically.
作者
徐珊
王敏
张小菜
宋丽华
XU Shan;WANG Min;ZHANG Xiao-cai;SONG Li-hua(Department of Obstetrics,the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang 712000,Shaanxi,CHINA;Department of Gynecology,the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang 712000,Shaanxi,CHINA)
出处
《海南医学》
CAS
2022年第13期1674-1677,共4页
Hainan Medical Journal
基金
陕西省卫生健康科研基金项目(编号:2018D085)
陕西省教育厅科学研究项目计划(编号:20JKO606)。
关键词
妊娠期糖尿病
亚临床型甲状腺功能减退症
25-羟基维生素D
糖脂代谢
心功能
临床意义
Gestational diabetes mellitus
Subclinical hypothyroidism
25 hydroxyvitamin D
Glucose and lipid metabolism
Cardiac function
Clinical significance
