孕期尿碘、TPOAB、FT4、TSH与妊娠期糖尿病患者胰岛素抵抗的相关性分析 [中文引用][英文引用]

目的 探讨妊娠期糖尿病患者孕期尿碘、甲状腺过氧化物酶抗体（TPOAB）、游离甲状腺素（FT4）、促甲状腺激素（TSH）水平变化与胰岛素抵抗的关系。方法 选取2016年3月至2018年2月在本院常规产前检查的52例妊娠期糖尿病患者（妊娠期糖尿病组），正常糖耐量孕妇60例（正常糖耐量组）为研究对象。检测两组尿碘、TPOAB、FT4、TSH水平，用HOMA 公式计算各组胰岛素抵抗指数，分析其相关性。结果 观察组FBG（5.13±1.76）mmol/L，2hPG为（8.22±1.03）mmol/L、HbA1C为（5.97±0. 35）%、空腹胰岛素为（14.38±2.75）mIU/L，胰岛素抵抗为（3.93±0.94），高于对照组，组间比较显著差异（P＜0.05）。观察组尿碘为（134.2±13.8）μg/L、TPOAB为（7.38±0.81）IU/ml、FT4为（5.27±0.35）pmol/L、TSH为（2.63±0.40）mIU/L，尿碘、FT4低于对照组，TPOAB、TSH高于对照组，组间比较显著差异（P＜0.05）。观察组血清TNF-a为（2.53±0.31）μg/ml、CRP为（7.42±1.10）mg/L、IL-6为（315.03±21.57）μg/ml、IL-17为（216.59±19.83）pg/ml，高于对照组，组间比较显著差异（P＜0.05）。根据Spearman法分析，尿碘、FT4水平与FBG、2hPG、HbA1C、胰岛素抵抗呈负相关（P＜0.05），TPOAB、TSH与FBG、2hPG、HbA1C、胰岛素抵抗呈正相关（P＜0.05）；CRP、TNF-α、IL-6、IL-17与尿碘、FT4、TPOAB、TSH水平具有相关性（P＜0.05）。结论 甲状腺功能亢进与妊娠期糖尿病患者胰岛素抵抗密切相关，可能参与妊娠期糖尿病的发生。

Objective To probe into the relationship between the changes of urinary iodine, thyroid peroxidase antibody (TPOAB), free thyroxine (FT4) and thyroid stimulating hormone (TSH) in patients with gestational diabetes. Method 52 cases of patients with gestational diabetes (gestational diabetes group) and 60 cases of pregnant women with normal glucose tolerance(normal glucose tolerance group) and who underwent the routine prenatal examination in our hospital from march,2016 to February,2018 were selected as the research objects. Then the levels of urine iodine, TPOAB, FT4 and TSH of two groups were detected, and the insulin resistance index of each group were calculated by HOMA formula, and the correlation were analyzed. Results In the observation group, the FBG was (5.13±1.76) mmol/L, 2hPG was (8.22±1.03) mmol/L, HbA1C was (5.97±0.35)%, fasting insulin was (14.38±2.75) mIU/L, and insulin resistance was (3.93±0.94),which was higher than those in the control group, and there was significant difference between the groups (P < 0.05).In the observation group,the urinary iodine was (134.2±13.8) g/L, TPOAB was (7.38±0.81) IU/ml, FT4 was (5.27±0.35) pmol/L, TSH was (2.63±0.40) mIU/L, the urinary iodine and FT4 were lower than those in the control group, the TPOAB and TSH were higher than those in the control group, and there was significant difference between the two groups (P<0.05).In the observation group, the serum TNF-a was (2.53±0.31) g/ml, CRP was (7.42±1.10) mg/L, IL-6 was (315.03±21.57) g/ml, IL-17 was (216.59±19.83) pg/ml, which was higher than those in the control group, and there was significant difference between the groups (P<0.05).According to Spearman analysis, the urinary iodine and FT4 levels were negatively correlated with FBG, 2hPG, HbA1C and insulin resistance (P<0.05).And the TPOAB and TSH were positively correlated with FBG, 2hPG, HbA1C and insulin resistance (P<0.05).The CRP, TNF- alpha, IL-6 and IL-17 were correlated with urinary iodine, FT4, TPOAB and TSH levels (P<0.05). Conclusions The hyperthyroidism is closely related to insulin resistance in patients with gestational diabetes mellitus, which it may be involved in the occurrence of gestational diabetes.