妊娠期甲状腺功能减退与妊娠期高血压疾病的相关性及对妊娠结局的影响OA
Correlation between hypothyroidism during pregnancy and hypertensive disorders of pregnancy and its impact on pregnancy outcomes
目的 研究妊娠期甲状腺功能减退(甲减)与妊娠期高血压疾病(HDP)的相关性及对妊娠结局的影响.方法 回顾性分析 2020-10 至 2023-12 武警福建总队医院 152 例孕产妇的临床资料,根据妊娠早期甲状腺功能分为正常组(60 例)、亚临床甲减组(66 例)及临床甲减组(26 例).对比三组甲状腺功能、血压、血脂、血糖水平及HDP、妊娠期糖尿病(GDM)的发生率,采用logistic回归分析不良妊娠结局的影响因素.结果 亚临床甲减组与临床甲减组的促甲状腺激素(TSH)、收缩压、舒张压、空腹血糖、餐后 2 h血糖、总胆固醇、低密度脂蛋白胆固醇(LDL-C)均高于正常组,高密度脂蛋白胆固醇(HDL-C)低于正常组,差异有统计学意义(P<0.05).logistic回归显示,亚临床甲减组与临床甲减组发生HDP风险分别为正常组的 3.82 倍(OR=3.816,95%CI:1.311～11.114)和 4.05 倍(OR=4.053,95%CI:1.149～14.296),发生GDM的风险分别为正常组的 3.77 倍(OR=3.769,95%CI:1.166～12.188)和 5.16 倍(OR=5.158,95%CI:1.359～19.583).经左甲状腺素规范治疗后,两组不良妊娠结局(早产、胎膜早破等)发生率(19.70%、26.92%)与正常组(13.33%)差异无统计学意义(P=0.308),校正代谢指标后风险趋近无效(亚临床甲减组OR=0.391,95%CI:0.103～1.481,P=0.167;临床甲减组OR=0.892,95%CI:0.221～3.593,P=0.872).结论 妊娠期甲减显著增加HDP及GDM风险,早期筛查甲状腺功能、强化血压与代谢指标监测,并规范左甲状腺素治疗,可有效改善妊娠结局.
Objective To investigate the correlation between hypothyroidism during pregnancy and hypertensive disorders of pregnancy(HDP)and its impact on pregnancy outcomes.Methods A retrospective analysis was conducted on the clinical data of 152 pregnant women admitted to Fujian Provincial Corps Hospital of Chinese People's Armed Police Force from October 2020 to December 2023.They were divided into three groups based on thyroid function in the early stage of pregnancy:a normal group(n=60),a sub-clinical hypothyroidism group(SCH,n=66),and an overt hypothyroidism group(OH,n=26).The thyroid function,blood pressure,blood lipid,blood glucose levels as well as the incidence of HDP and gestational diabetes mellitus(GDM)were compared among the three groups.Logistic regression was used to analyze factors influencing adverse pregnancy outcomes.Results Compared with the nor-mal group,the SCH and OH groups had significantly higher thyroid stimulating hormone(TSH),systolic/diastolic blood pressure,fasting/2-hour postprandial blood glucose,total cholesterol,and low-density lipoprotein cholesterol(LDL-C),and lower high-density lipoprotein cholesterol(HDL-C),with statistically significant differences(P<0.05).Logistic regression showed that the risk of HDP in the SCH and OH groups was 3.82 times(OR=3.816,95%CI:1.311-11.114)and 4.05 times(OR=4.053,95%CI:1.149-14.296)than that of the normal group,respectively,and the risk of GDM was 3.77 times(OR=3.769,95%CI:1.166-12.188)and 5.16 times(OR=5.158,95%CI:1.359-19.583)than that of the normal group,respectively.After standardized treatment with levothyroxine,the incidence of adverse pregnancy outcomes(preterm birth,premature rupture of membranes,etc.)in the SCH and OH groups(19.70%and 26.92%)was not statistically different from that in the normal group(13.33%)(P=0.308).After adjusting for metabolic indicators,the risks tended to be insignificant(SCH a group:OR=0.391,95%CI:0.103-1.481,P=0.167;OH group:OR=0.892,95%CI:0.221-3.593,P=0.872).Conclusions Hypothyroidism during pregnancy significantly elevates the risk of HDP and GDM.Early-stage screening of thyroid func-tion,intensified monitoring of blood pressure and metabolic parameters,and standardized levothyroxine treatment can effectively im-prove pregnancy outcomes.
陈守月;陈婷;张宗静
350001 福州,武警福建总队医院 妇产科350001 福州,武警福建总队医院 内一科250031 济南,联勤保障部队 960 医院内分泌科
医药卫生
妊娠期甲状腺功能减退妊娠期高血压疾病相关性妊娠结局
pregnancyhypothyroidismhypertensive disorders of pregnancycorrelationpregnancy outcome
《武警医学》 2026 (3)
185-190,197,7
评论