多内分泌代谢性卵巢综合征孕妇的母体甲状腺功能与后续胰岛素抵抗标志物。
完整摘要 · 中文译文
目的：母亲低游离甲状腺素（fT4）水平与胰岛素抵抗标志物及妊娠期糖尿病相关。我们的主要目的是研究在多内分泌代谢性卵巢综合征（PMOS，以前称为PCOS）孕妇中，母亲甲状腺功能是否与随后的胰岛素抵抗相关。 方法：在这两项随机对照试验的事后分析中，我们使用线性回归分析来检验促甲状腺激素（TSH）和fT4与代谢谱参数（负荷前和负荷后血糖、空腹胰岛素和胰岛素抵抗稳态模型评估（HOMA-IR））在284名PMOS孕妇中的关联，这些孕妇在妊娠早期被随机分配至二甲双胍或安慰剂。血液样本在妊娠周（gw）5至12、19、32和36时采集。在入组时、gw19和32时进行口服葡萄糖耐量试验。 结果：基线时，这些女性的平均体重指数（BMI）为28.9，HOMA-IR为3.2，没有人患有明显的甲状腺功能减退症。我们发现妊娠期间TSH的变化与gw19时的负荷后血糖以及gw36时的空腹血糖之间存在显著的负向关联，即母亲TSH升高幅度越小，随后母亲血糖水平越高。此外，较低的母亲fT4水平与随后较高的胰岛素/HOMA-IR水平显著相关，TSH的变化也与gw32时的HOMA-IR呈负向关联。所有关联均独立于二甲双胍或安慰剂治疗。 结论：在这项探索性事后分析中，一项 超重且患PMOS的妇女妊娠期母体TSH升高幅度较小和fT4水平较低，与妊娠后期随后出现的更高血糖和胰岛素/HOMA-IR水平相关。
完整摘要 · 英文原文
OBJECTIVES: Low maternal free thyroxine (fT4) levels have been associated with markers of insulin resistance and gestational diabetes. Our primary aim was to investigate whether maternal thyroid function was associated with subsequent insulin resistance in pregnant women with polyendocrine metabolic ovary syndrome (PMOS, previously known as PCOS). METHODS: In this post-hoc analysis of two randomized controlled trials, we used linear regression analyses to examine associations of thyroid stimulating hormone (TSH) and fT4 with parameters of metabolic profile (pre- and post-load glucose, fasting insulin and homeostatic model assessment of insulin resistance (HOMA-IR) in 284 pregnant women with PMOS who were randomized to metformin or placebo in early pregnancy. Blood samples were drawn at gestational weeks (gw) 5 to12, 19, 32 and 36. An oral glucose tolerance test was performed at inclusion, gw19 and 32. RESULTS: At baseline, the women had a mean body mass index (BMI) of 28.9 and HOMA-IR 3.2, and none had overt hypothyroidism. We found significant inverse associations between the change in TSH during pregnancy and post-load glucose at gw19, as well as fasting glucose at gw36, i.e. the smaller increase in maternal TSH, the higher subsequent maternal glucose levels. Furthermore, lower maternal fT4 levels were significantly associated with higher subsequent insulin/HOMA-IR levels, and the change in TSH was also inversely associated with HOMA-IR at gw32. All associations were independent of treatment with metformin or placebo. CONCLUSIONS: In this exploratory post-hoc analysis, a smaller maternal TSH increase and lower fT4 levels during pregnancy in overweight women with PMOS are associated with higher subsequent glucose and insulin/HOMA-IR levels later in pregnancy.