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目的探讨甲状腺功能减退对妊娠期糖尿病(GDM)患者胰岛素抵抗及敏感性的影响。方法对80例GDM患者进行甲状腺功能检测,30例合并甲状腺功能减退症(甲减)患者为甲减组,50例甲状腺功能正常者为对照组,测定两组患者空腹血糖(FBG)和空腹胰岛素(INS),比较两组INS、胰岛素抵抗指数(HOMA-IR)和胰岛素敏感性指数(ISI),分析GDM患者的胰岛素敏感性与甲状腺功能之间的关系。结果甲减组GDM的INS(14.52±4.42)μIU/ml明显高于对照组的(10.68±3.37)μIU/ml;HOMAIR(3.98±2.29)明显高于对照组的(2.73±1.61),ISI(0.012±0.07)明显低于对照组的(0.021±0.09),差异均有统计学意义(P<0.05)。甲减组FBG与对照组比较,差异无统计学意义(P>0.05)。GDM患者的INS与游离三碘甲腺原氨酸(FT_3)、游离甲状腺素(FT_4)呈明显负相关(r=-0.436、-0.439,P<0.05);HOMA-IR与FT_3、FT_4呈明显负相关(r=-0.425、-0.428,P<0.05);ISI与FT_3、FT_4呈明显负相关(r=-0.358、-0.367,P<0.05)。结论 GDM患者甲减低会导致胰岛素抵抗程度升高,胰岛素敏感性降低,且胰岛素抵抗程度和胰岛素敏感性与FT_3、FT_4呈明显负相关。
Objective To investigate the effect of hypothyroidism on insulin resistance and sensitivity in patients with gestational diabetes mellitus (GDM). Methods Eighty patients with GDM were tested for thyroid function, 30 hypothyroidism (hypothyroidism) hypothyroidism, 50 normal thyroid function as control group, fasting blood glucose (FBG) and fasting insulin (INS). The INS, insulin resistance index (HOMA-IR) and insulin sensitivity index (ISI) were compared between two groups to analyze the relationship between insulin sensitivity and thyroid function in GDM patients. Results The hypothyroidism group had significantly higher INS (14.52 ± 4.42) μIU / ml than that of the control group (10.68 ± 3.37 μIU / ml); HOMAIR (3.98 ± 2.29) was significantly higher than that of the control group (2.73 ± 1.61) 0.012 ± 0.07) was significantly lower than that of the control group (0.021 ± 0.09), the differences were statistically significant (P <0.05). The hypothyroidism group FBG compared with the control group, the difference was not statistically significant (P> 0.05). There was a significant negative correlation between INS and free triiodothyronine (FT_3) and free thyroxine (FT_4) in GDM patients (r = -0.436, -0.439, P <0.05); HOMA-IR, FT_3 and FT_4 were significantly (R = -0.425, -0.428, P <0.05). ISI was negatively correlated with FT_3 and FT_4 (r = -0.358, -0.367, P <0.05). Conclusion The hypothyroidism in patients with GDM leads to the increase of insulin resistance and insulin sensitivity, and the negative correlation between insulin resistance and insulin sensitivity and FT_3 and FT_4.