国际生殖健康/计划生育杂志

国际生殖健康/计划生育 ›› 2019, Vol. 38 ›› Issue (2): 113-115.

• 论著 • 上一篇    下一篇

妊娠期糖尿病合并亚临床甲状腺功能减退患者炎性应激状态及凝血功能对妊娠结局的影响

甘毓舒，杨玉综，王燕，孙强   

  1. 723000 陕西省汉中市中心医院产科（甘毓舒，王燕）；西安交通大学医学院第一附属医院检验科（杨玉综）；陕西省汉中市中心医院检验科（孙强）
  • 收稿日期:2018-08-12 修回日期:2018-11-02 出版日期:2019-03-15 发布日期:2019-03-15

Inflammatory Stress and Coagulation Function in Patients with Gestational Diabetes Mellitus and Subclinical Hypothyroidism, and Effect on Pregnancy Outcome

GAN Yu-shu，YANG Yu-zong，WANG Yan，SUN Qiang   

  1. Department of Obstetrics，Hanzhong Central Hospital，Hanzhong 723000，Shanxi Province，China（GAN Yu-shu，WANG Yan）；Clinical Laboratory，First Affiliated Hospital of Xi'an Jiao Tong University Medical College，Xi'an 710000，China（YANG Yu-zong）；Clinical Laboratory，Hanzhong Central Hospital，Hanzhong 723000，Shanxi Province，China（SUN Qiang）
  • Received:2018-08-12 Revised:2018-11-02 Published:2019-03-15 Online:2019-03-15

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摘要： 目的：探讨妊娠期糖尿病（GDM）合并亚临床甲状腺功能减退（SCH）患者炎症因子及凝血功能变化，及其对妊娠结局的影响。方法：本研究纳入2016年10月—2017年12月陕西省汉中市中心医院产科收治的60例GDM合并SCH患者（合并组）、55例单纯GDM患者（单纯组）及60例健康孕妇（对照组）。比较3组的炎症因子水平、凝血功能及妊娠结局。结果：与对照组比较，单纯组和合并组的肿瘤坏死因子α（TNF-α）、超敏C反应蛋白（hs-CRP）及纤维蛋白原（FIB）水平均显著升高，且合并组水平高于单纯组，差异有统计学意义（P＜0.05）。3组活化部分凝血活酶时间（APTT）及凝血酶原时间（PT）比较，差异无统计学意义（P＞0.05）。3组胎儿生长受限（FGR）发生率差异有统计学意义（P＜0.05），单纯组及合并组高于对照组，合并组高于单纯组。3组剖宫产率差异有统计学意义（P＜0.05），合并组高于对照组及单纯组（P＜0.05），单纯组与对照组差异无统计学意义（P＞0.05）。3组早产及胎盘早剥发生率差异无统计学意义（P＞0.05）。结论：GDM合并SCH可造成FIB水平异常，显著升高机体炎性应激反应，并能增加FGR及剖宫产等不良结局发生风险，临床中应加强监测。

关键词: 糖尿病, 妊娠, 甲状腺功能减退症, 肿瘤坏死因子α, C反应蛋白质, 凝血酶原时间, 纤维蛋白原, 妊娠结局

Abstract: Objective：To investigate the inflammatory factors and coagulation function in patients with gestational diabetes mellitus (GDM) and subclinical hypothyroidism (SCH), and the effects on the pregnancy outcome. Methods：Sixty GDM patients with SCH (the combined group), 55 GDM patients (the simple group) and 60 healthy pregnant women (the control group) were selected. The inflammatory factors, coagulation function and pregnancy outcome in the three groups were compared. Results：Compared with the control group, the level of tumor necrosis factor-α (TNF-α), hypersensitive C-reactive protein (hs-CRP) and fibrinogen (FIB) in the simple group and the combined group were increased significantly (P＜0.05). The above parameters in the combined group were significantly higher than those in the simple group (P＜0.05). There were no significant differences in the levels of activated partial thromboplastin time (APTT) and prothrombin time (PT) among the three groups (P＞0.05). The rate of fetal growth restriction in the simple group and the combined group was significantly higher than that in the control group. The rate of cesarean section in the combined group was significantly higher than that in the control group or the simple group (P＜0.05). There were no significant differences in the incidences of preterm birth and placental abruption in the three groups (P＞0.05). Conclusions：GDM combined with SCH can cause abnormal FIB level, which significantly increases the inflammatory stress and the risk of adverse effects such as fetal growth restriction and cesarean section. Monitoring the inflammatory stress and coagulation function in those patients with GDM and SCH should be strengthened in clinical practice.

Key words: Diabetes, gestational, Hypothyroidism, Tumor necrosis factor-alpha, C-reactive protein, Prothrombin time, Fibrinogen, Pregnancy outcome