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目的探讨亚临床甲状腺功能减退(SCH)及其甲状腺过氧化物酶抗体(TPOAb)阳性孕妇治疗与否对妊娠期糖尿病(GDM)发病率的影响。方法在经甲状腺功能筛查诊断为SCH的孕妇中,按是否愿意接受左旋甲状腺素(L-T)治疗,选取治疗及不治疗的SCH孕妇各360例为SCH组;甲状腺功能正常孕妇720例为对照组。SCH组中根据TPOAb检测结果分为TPOAb(+)治疗组117例、TPOAb(+)未治疗组131例;TPOAb(-)治疗组243例、TPOAb(-)未治疗组229例。比较SCH组与对照组的TPOAb阳性率情况,TPOAb(+)组与TPOAb(-)组的治疗率,并根据口服糖耐量试验(OGTT)结果比较各组GDM发病率。结果 1SCH组的TPOAb阳性率高于对照组(P<0.01)。TPOAb阳性组治疗率与TPOAb阴性组比较差异无统计学意义(P>0.05)。2SCH组中GDM发病率高于对照组(P<0.05)。SCH治疗组360例中发病率低于SCH未治组360例,差异有统计学意义(P<0.05)。SCH治疗组的发病率与对照组无明显差异(P>0.05),SCH未治组的发病率高于对照组(P<0.01)。3TPOAb(+)组的GDM总体发病率高于对照组(P<0.01),其中TPOAb(+)治疗组发病率与对照组无明显差异(P>0.05),TPOAb(+)未治疗组中发病率明显高于对照组(P<0.01),也高于TPOAb(+)治疗组(P<0.05)。4TPOAb阴性组中,GDM总体发病率高于对照组,但差异无统计学意义(P>0.05);其中TPOAb(-)治疗组发病率与对照组无明显差异(P>0.05),而TPOAb(-)未治疗组发病率高于对照组,差异无统计学意义(P>0.05),且与TPOAb(-)治疗组比较也无明显差异(P>0.05)。结论 SCH会增加孕妇尤其是TPOAb阳性孕妇的GDM发病风险,使用L-T有利于改善SCH特别是TPOAb阳性孕妇的GDM的发病率。
Objective To investigate the effect of subclinical hypothyroidism (SCH) and thyroid peroxidase antibody (TPOAb) -positive pregnant women on the incidence of gestational diabetes mellitus (GDM). Methods Among pregnant women who were diagnosed as SCH by thyroid function screening, 360 pregnant women were enrolled in SCH group according to whether they were willing to receive levothyroxine (LT) or not, and 720 pregnant women with normal thyroid function as control group . According to the results of TPOAb in SCH group, 117 cases were treated with TPOAb (+), 131 cases with TPOAb (+) untreated, 243 cases with TPOAb (-) and 229 cases with TPOAb (-) untreated. The positive rates of TPOAb in SCH group and control group were compared, and the treatment rates of TPOAb (+) group and TPOAb (-) group were compared. The incidence of GDM was compared between the two groups according to oral glucose tolerance test (OGTT). Results The positive rate of TPOAb in 1SCH group was higher than that in control group (P <0.01). There was no significant difference between TPOAb positive group and TPOAb negative group (P> 0.05). The incidence of GDM in 2SCH group was higher than that in control group (P <0.05). The morbidity of 360 cases in SCH group was lower than that in SCH group, the difference was statistically significant (P <0.05). The incidence of SCH in the treatment group was not significantly different from that in the control group (P> 0.05). The incidence of SCH in the untreated group was higher than that in the control group (P <0.01). The overall incidence of GDM in the 3TPOAb (+) group was higher than that in the control group (P <0.01). There was no significant difference in the incidence of GDM between the TPOAb (+) group and the control group (P> 0.05) The rate was significantly higher than that of the control group (P <0.01) and also higher than that of the TPOAb (+) group (P <0.05). The overall incidence of GDM in the 4TPOAb-negative group was higher than that in the control group, but the difference was not statistically significant (P> 0.05). There was no significant difference between the TPOAb (-) group and the control group (P> 0.05) -) in the untreated group was higher than that in the control group, with no significant difference (P> 0.05). There was no significant difference between the two groups (P> 0.05). Conclusions SCH may increase the risk of GDM in pregnant women, especially in TPOAb-positive pregnant women. The use of L-T can improve the incidence of GDM in SCH, especially in TPOAb-positive pregnant women.