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目的探讨妊娠合并甲亢对母婴代谢指标和预后的影响。方法选取2011年5月-2016年1月该院收治的妊娠合并甲亢孕妇52例,经系统治疗后分娩前甲状腺功能基本恢复正常者34例(疾病控制组),未经系统治疗或经短暂治疗后中途停药者18例(未控制组);另选取同期在该院进行孕检及分娩的甲状腺功能正常孕妇50例(正常对照组)。分娩前,采用酶联免疫吸附法(ELISA)检测甲状腺激素含量;采用放射免疫法检测糖代谢指标水平,计算胰岛素抵抗指数(HOMA-IR)及胰岛素敏感指数(ISI);采用全自动生化分析仪检测脂质代谢指标含量;随访并记录3组孕妇及新生儿的分娩结局。结果未控制组孕妇的血清游离三碘甲腺原氨酸(FT_3)、游离甲状腺素(FT_4)含量高于疾病控制组、正常对照组,促甲状腺激素(TSH)含量低于疾病控制组(P<0.05);外周血空腹血糖(FPG)、空腹胰岛素(FINS)、HOMA-IR及ISI绝对值水平均高于疾病控制组、正常对照组(P<0.05);外周血总胆固醇(TC)、甘油三酯(TG)含量高于疾病控制组、正常对照组,高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A-Ⅰ(ApoA-Ⅰ)含量低于疾病控制组、正常对照组(P<0.05);母体结局中流产引产率高于疾病控制组、正常对照组,新生儿结局中死胎、低出生体重、新生儿甲亢发生率高于疾病控制组、正常对照组(P<0.05)。结论妊娠合并甲亢可导致孕妇糖代谢及脂质代谢异常,病情未经控制者母体及新生儿预后不佳。
Objective To investigate the influence of pregnancy complicated with hyperthyroidism on the metabolic parameters and prognosis of maternal and infant. Methods From May 2011 to January 2016, 52 pregnant women with hyperthyroidism during pregnancy were treated in our hospital. Thirty-four patients (disease control group) with normal thyroid function returned to normal before delivery after systemic treatment were either untreated or treated transiently After discontinuation of 18 cases (uncontrolled group); the other 50 cases of normal thyroid function pregnant women (normal control group) were enrolled in this study. Before delivery, the content of thyroid hormone was detected by enzyme-linked immunosorbent assay (ELISA); the level of glucose metabolism was measured by radioimmunoassay; the index of insulin resistance (HOMA-IR) and insulin sensitivity index (ISI) The content of lipid metabolism index was detected; the delivery outcomes of 3 groups of pregnant women and newborns were recorded and followed up. Results The levels of free triiodothyronine (FT_3) and free thyroxine (FT_4) in pregnant women in the control group were significantly higher than those in the disease control group, the normal control group and the thyroid stimulating hormone (TSH) group <0.05). The levels of fasting blood glucose (FPG), fasting insulin (FINS), HOMA-IR and ISI in peripheral blood were higher than those in control group and normal control group (P <0.05) Triglyceride (TG) content was higher than that in disease control group. The content of HDL-C and ApoA-Ⅰ in control group was lower than that in disease control group and normal control group P <0.05). The rate of induced abortion in maternal outcome was higher than that in disease control group. The incidence of stillbirth, low birth weight and neonatal hyperthyroidism in the control group was higher than that in the disease control group and the normal control group (P <0.05) . Conclusions Pregnancy complicated with hyperthyroidism can lead to abnormal glucose metabolism and lipid metabolism in pregnant women. The prognosis of maternal and newborn infants with uncontrolled condition is not good.