标题：孕期体质量增长及甲状腺激素水平对妊娠期糖尿病发病的影响

      作者：赵敏，吴曼莉    汉中市中心医院产科，陕西 汉中 723000

      卷次： 2019年30卷9期

      【摘要】 目的 探讨孕期体质量增长及血清甲状腺激素各项指标的变化对妊娠期糖尿病(GDM)发病的影响。方法 收集2017年1月至2018年6月在汉中市中心医院产科就诊的243例GDM患者为病例组，并以年龄段为匹配因素进行 l：1的频数配对，以243例糖耐量试验正常的孕妇作为对照组。收集两组孕妇的年龄、孕前体质量、身高、每次产检的孕周及体质量，检测孕早期(孕 13周前)空腹血糖、糖耐量结果及孕早期(孕 13周前)、孕中期(孕19~20周)、孕晚期(孕36~37周)的血清甲状腺激素水平等资料，分析GDM的影响因素。结果 孕早期GDM组与对照组的空腹血糖分别为(5.21±0.52) mmol/L和(4.12±0.55) mmol/L，差异有统计学意义(P<0.05)；孕中期，GDM组与对照组游离四碘甲状腺原氨酸 (FT4) [(6.53±1.08) pmol/L vs (7.78±1.24) pmol/L]和促甲状腺激素 (TSH) [(2.33±0.78) mIU/L vs (1.71±0.89) mIU/L]水平比较差异均有统计学意义(P<0.05)；多因素Logistic回归分析结果显示，孕前身体质量指数(BMI)≥24.0 kg/m2、孕早期空腹血糖≥5.20 mmol/L、孕中期FT4<4.0 pmol/L、孕中期TSH≥0.8 mU/L及孕中期平均每周体质量增长≥0.80 kg/(cm2·周)均是GDM发病的独立危险因素(P<0.05)。结论 临床上应关注孕前BMI≥24.0 kg/cm2、孕早期空腹血糖≥5.20 mmol/L、孕中期平均每周体质量增长≥0.80 kg/(cm2·周)及孕中期 FT4<4.0 pmol/L、TSH≥0.8 mIU/L的孕妇。
      【关键词】 身体质量指数；体质量增长；甲状腺激素；妊娠期糖尿病；危险因素
      【中图分类号】 R714.256 【文献标识码】 A 【文章编号】 1003—6350（2019）09—1151—04

Effect of the body weight gain during pregnancy and the levels of serum thyroid hormones on the occurrence ofgestational diabetes mellitus.
ZHAO Min, WU Man-li. Department of Obstetrics, Hanzhong Central Hospital, Hanzhong723000, Shaanxi, CHINA
【Abstract】 Objective To analyze the effect of body weight gain during pregnancy and the levels of the serumthyroid hormones on the occurrence of gestational diabetes mellitus (GDM). Methods Totally 243 gestational diabetesmellitus women (GDM group) in Hanzhong Central Hospital were recruited in this study from January 2017 to June2018. Meanwhile, 243 pregnant women whose levels of the glucose were normal were chosen as the control group. Theage, body weight before pregnancy, height, gestational weeks and body weight of pregnant women in the two groupswere collected. The results of fasting blood glucose, glucose tolerance, and serum thyroid hormone levels in early preg-nancy (before 13 weeks of pregnancy), mid-pregnancy (19-20 weeks of pregnancy), and late pregnancy (36-37 weeks ofpregnancy) were measured. The influencing factors of GDM were analyzed. Results There were significant differencesbetween the GDM group and the control group in the levels of fasting blood glucose in early pregnancy, and in the levelsof free tetraiodothyronine (FT4), thyroid-stimulating hormone (TSH) in mid-pregnancy: fasting blood glucose (5.21 ±0.52) mmol/L vs (4.12±0.55) mmol/L, P<0.05; FT4 (6.53±1.08) pmol/L vs (7.78±1.24) pmol/L, P<0.05; TSH (2.33±0.78) mIU/L vs (1.71±0.89) mIU/L, P<0.05. Multivariate Logistic regression analysis showed that pre-pregnancy BMl≥24.0 kg/cm2, fasting blood glucose in early pregnancy≥5.20 mmol/L, mid-pregnancy FT4 <4.0 pmol/L, mid-pregnancyTSH≥0.8 mIU/L, and average weekly weight gain≥0.80 kg/(cm2·week) were the independent risk factors for the onsetof GDM. Conclusion In clinical practice, the pregnant women with pre-pregnancy BMI≥24.0 kg/m2, fasting plasmaglucose in early pregnancy≥5.2 mmol/L, average weekly weight gain of mid-pregnancy≥0.80 kg/(cm2·week), FT4 ofmid-pregnancy<4.0 pmol/L, TSH≥0.8 mIU/L should be paid more attention.
      【Key words】 Body mass index (BMI); Body weight gain; Thyroid hormones; Gestational diabetes mellitus(GDM); Risk factor