本文關(guān)鍵詞：妊娠期甲狀腺疾病與妊娠期糖尿病的關(guān)聯(lián)研究　出處：《上海交通大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 甲狀腺功能異常 低甲狀腺素血癥 妊娠期糖尿病 妊娠結(jié)局 妊娠

【摘要】：目的:1.評估妊娠早期甲狀腺疾病與妊娠期糖尿病(GDM)的發(fā)生是否具有關(guān)聯(lián)性;2.分析妊娠期甲狀腺功能異常與GDM合并存在是否可對妊娠結(jié)局造成較多不良影響。方法:1.依照納入及排除標(biāo)準收集本院9705例孕婦為研究對象,檢測其妊娠早期甲狀腺功能指標(biāo)并分組(臨床甲減組、亞臨床甲減組、臨床甲亢組、亞臨床甲亢組、低甲狀腺素血癥組和單純TPOAb陽性組)。GDM的診斷采用口服葡萄糖耐量試驗,并收集三點血糖值。統(tǒng)計分析甲狀腺功能指標(biāo)與血糖指標(biāo)間是否存在線性依存關(guān)系及妊娠早期各種甲狀腺疾病是否增加GDM的發(fā)生風(fēng)險。2.研究對象的入選方法同上。采用零膨脹泊松回歸模型和多元logistic回歸模型來分析TSH、FT4及TPOAb水平異常且分別合并GDM時與巨大兒、胎兒窘迫、妊娠期高血壓疾病、羊水污染、胎膜早破和早產(chǎn)的發(fā)生是否具有相關(guān)性。結(jié)果:1.低甲狀腺素血癥組三點血糖值均比甲狀腺功能正常組高(t=-4.54,P㩳0.001;t=-6.96,P㩳0.001;t=-5.82,P㩳0.001);2.各組甲狀腺疾病中僅低甲狀腺素血癥組(16.73%)GDM的發(fā)病率較甲狀腺功能正常組(9.57%)高(χ2=32.10,P㩳0.001);3.多元線性回歸發(fā)現(xiàn)FT4水平與三點血糖值均呈負相關(guān);4.在調(diào)整孕婦年齡和BMI后,低甲狀腺素血癥組仍可增加GDM 49%的發(fā)生率(OR 1.49,95%CI 1.19-1.87);FT4水平從1pmol/L升高到45pmol/L時,GDM的發(fā)生率從26.48%下降到0.71%(P=0.002);5.單純TPOAb陽性合并GDM分娩巨大兒的可能性增高(t=2.29,P=0.022);6.當(dāng)?shù)虵T4水平合并GDM以及單純TPOAb陽性合并GDM時與早產(chǎn)的發(fā)生呈正相關(guān)(t=3.26,P=0.001;t=2.66,P=0.008);7.單純TPOAb陽性合并GDM可增加胎膜早破1.09倍(OR 2.09,95%CI1.19-3.67)的發(fā)生風(fēng)險。結(jié)論:1.妊娠早期低甲狀腺素血癥是GDM發(fā)生的危險因素,FT4是GDM的保護因素;2.單純TPOAb陽性合并GDM時,分娩巨大兒的可能性增高;3.低FT4水平合并GDM及單純TPOAb陽性合并GDM與早產(chǎn)的發(fā)生呈正相關(guān);4.單純TPOAb陽性合并GDM可增加胎膜早破1.09倍的發(fā)生風(fēng)險。
[Abstract]:Objective: To evaluate 1. early pregnancy thyroid disease and gestational diabetes mellitus (GDM) is the relevance of the 2. generation; analysis of gestational thyroid dysfunction and GDM and whether there can be adverse effects more on pregnancy outcome. Methods: 1. in accordance with inclusion and exclusion criteria used in our hospital 9705 cases of pregnant women as the research object, its detection early pregnancy thyroid function index and group (clinical hypothyroidism group, subclinical hypothyroidism group, clinical hyperthyroidism group, subclinical hyperthyroidism group and hypothyroxinemia group and TPOAb positive group) in the diagnosis of.GDM by oral glucose tolerance test, and collected three blood glucose values. Statistical analysis of the existence of linear dependency relation and early pregnancy all kinds of thyroid disease whether to increase the occurrence of GDM of.2. was selected. Risk function index and glycemic index of thyroid. Using zero inflated Poisson regression model and multiple Logistic regression analysis of TSH, FT4 and TPOAb respectively and the abnormal level with GDM and macrosomia, fetal distress, hypertension, pregnancy, amniotic fluid pollution, whether there is correlation between premature rupture of membranes and preterm birth. Results: 1. hypothyroxinemia group of three blood glucose values were higher than normal thyroid function group (t=-4.54. P? 0.001; t=-6.96, 0.001; P? T=-5.82, P? 0.001); 2. were thyroid disease only in hypothyroxinemia group (16.73%) the incidence of GDM compared with normal thyroid function group (9.57%) and high (x 2=32.10, P? 0.001); 3. multivariate linear regression found that FT4 levels and blood glucose values three in 4. were negatively correlated; adjustment of maternal age and BMI, hypothyroxinemia group can increase the incidence rate of GDM 49% (OR 1.49,95%CI 1.19-1.87); the level of FT4 increased from 1pmol/L to 45pmol/L, the incidence rate of GDM decreased from 26.48% to 0.71% (P=0.002); 5. with positive TPOAb The possibility of increased with GDM fetal macrosomia (t=2.29, P=0.022); 6. when the lower level of FT4 and GDM and simple TPOAb positive with GDM and preterm birth was positively correlated (t=3.26, P=0.001; t=2.66, P=0.008; 7.) with positive TPOAb combined with GDM can increase the prom 1.09 times (OR 2.09,95%CI1.19-3.67) risk 1.. Conclusion: early pregnancy hypothyroxinemic are risk factors of GDM, FT4 is a protective factor for GDM; 2. with positive TPOAb with GDM, the possibility of increased fetal macrosomia; 3. was positively correlated with low levels of FT4 combined with GDM and TPOAb alone with positive GDM and preterm birth related risk; 4. only with positive TPOAb GDM can increase the prom 1.09 times.

【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R714.256

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