2020 年第 5 期 第 15 卷

妊娠早期甲状腺球蛋白抗体阳性对妊娠期糖尿病发生风险和妊娠结局的影响

Effect of thyroglobulin antibody on gestational diabetes mellitus in early pregnancy and pregnancy outcome

作者：龙宁;刘跃辉;徐凡;罗岳西;林川;蒋海霞

英文作者：Long Ning Liu Yuehui Xu Fan Luo Yuexi Lin Chuan Jiang Haixia

单位：四川省南充市中心医院妇产科637000

英文单位：Department of Obstetrics and Gynecology Nanchong Central Hospital Sichuan Province Nanchong 637000 China

关键词：妊娠期糖尿病；甲状腺球蛋白抗体；妊娠结局

英文关键词：Gestationaldiabetes；Thyroglobulinantibody；Pregnancyoutcome

• 摘要：

• 目的 探讨妊娠早期甲状腺球蛋白抗体(TgAb)阳性对妊娠期糖尿病和妊娠结局的影响。方法 选择2016年1月至2019年1月于四川省南充市中心医院妇产科就诊的妊娠早期孕妇398例作为研究对象，其中TgAb阳性者为TgAb组（128例），其余TgAb阴性者为对照组（270例）。比较2组患者一般资料和妊娠不良结局发生情况，分析妊娠期糖尿病的影响因素和TgAb阳性预测妊娠期糖尿病的敏感度和特异度。结果 TgAb组年龄、体重指数、腹围、空腹血糖、口服葡萄糖耐量试验（OGTT）负荷后2 h血糖均明显高于对照组［（28±5）岁比（27±5）岁、（27±3）kg/m2比（26±3）kg/m2、（83±6）cm比（81±4）cm、（4.8±2.1）mmol/L比（4.3±1.9）mmol/L、（5.9±0.8）mmol/L比（5.6±0.8）mmol/L］，血肌酐水平明显低于对照组［（46±8）μmol/L比（50±8）μmol/L］，差异均有统计学意义（均P＜0.05）。TgAb组妊娠期糖尿病、妊娠高血压、自然流产、剖宫产发生率均明显高于对照组［16.4%(21/128)比9.3%(25/270)、25.0%(32/128)比8.1%(22/270)、21.9%(28/128)比7.7%(21/270)、9.4%(12/128)比3.0%(8/270)］，胎膜早破发生率明显低于对照组［18.0%(23/128)比30.0%(81/270)］，差异均有统计学意义（均P＜0.05）。OGTT负荷后2 h血糖、TgAb是妊娠期糖尿病发生的独立危险因素（比值比=4.568、2.391，95%置信区间：2.323～8.982、1.085～5.268，P=0.003、0.036）。TgAb阳性预测妊娠期糖尿病的敏感度和特异度分别为45.6%（21/46）和69.6%（245/352）。结论TgAb阳性会增加妊娠期糖尿病的发病风险，同时增加妊娠不良结局发生率。

• Objective To explore the effect of thyroglobulin antibodies(TgAb) in early pregnancy on gestational diabetes and pregnancy outcomes. Methods Totally 398 pregnant women in the early pregnancy who visited the Department of Obstetrics and Gynecology of Nanchong Central Hospital from January 2016 to January 2019 were selected. TgAb positive women were selected as TgAb group (128 cases)and the TgAb negative women were selected as the control group (270 cases). The general data of the two groups were compared;the influencing factors of gestational diabetes mellitus were analyzed; the adverse pregnancy outcomes in the two groups were compared; the sensitivity and specificity of TgAb in predicting gestational diabetes mellitus were analyzed. Results Age, body mass index, abdominal circumference, fasting blood glucose and blood glucose 2 hours after oral glucose tolerance test(OGTT) in TgAb group were significantly higher than those in control group ［（28±5）years vs （27±5）years,（27±3）kg/m2 vs （26±3）kg/m2,（83±6）cm vs （81±4）cm,（4.8±2.1）mmol/L vs （4.3±1.9）mmol/L,（5.9±0.8）mmol/L vs （5.6±0.8）mmol/L］; the level of blood creatinine was significantly lower than that in control group［（46±8）μmol/L vs （50±8）μmol/L］（all P＜0.05）. The incidences of gestational diabetes mellitus, gestational hypertension, spontaneous abortion and cesarean section in TgAb group were significantly higher than those in control group ［16.4% (21/128) vs 9.3% (25/270), 25.0% (32/128) vs 8.1% (22/270), 21.9% (28/128) vs 7.7% (21/270), 9.4% (12/128) vs 3.0% (8/270)］; the incidence of premature rupture of membranes in TgAb group was significantly lower than that in control group ［18.0% (23/128) vs 30.0% (81/270)， all P＜0.05］. Blood glucose 2 h after OGTT and TgAb were independent risk factors for gestational diabetes mellitus（odds ratio =4.568, 2.391， 95% confidence interval： 2.323-8.982, 1.085-5.268， P=0.003, 0.036）. The sensitivity and specificity of TgAb positive in predicting gestational diabetes mellitus were 45.6%(21/46) and 69.6%(245/352), respectively. ConclusionPositive TgAb increases the risk of gestational diabetes and also increases the incidence of adverse pregnancy outcomes.