肠道菌群与妊娠期甲状腺功能减退的关联性分析-现代医学

肠道菌群与妊娠期甲状腺功能减退的关联性分析

单位：苏州市第九人民医院妇产科, 江苏苏州 215200

分类号：R714.46

出版年·卷·期（页码）：2022·50·第一期（85-89）

摘要：

目的：探讨肠道菌群与妊娠期甲状腺功能减退的关联性。方法：选取2019年7月至2021年4月在我院进行常规产前检查的466例孕妇作为研究对象。根据肠道菌群诊断情况分为肠道菌群失调组(n=85)和肠道菌群正常组(n=381)。通过检测两组的血清促甲状腺激素(TSH)、游离甲状腺素(FT₄)水平，判断并比较两组妊娠期甲状腺功能减退的发生情况。并以孕妇是否发生甲减划分为甲减组与非甲减组，观察甲减与非甲减孕妇的肠道各菌群分布情况。采用多因素Logistic回归模型检验肠道菌群与妊娠期甲状腺功能减退的关系。结果：肠道菌群失调组妊娠期甲状腺功能减退的发生率为34.12%,明显高于肠道菌群正常组的4.72%(χ²=66.208，P<0.001)。妊娠期甲减组孕妇的肠道总菌群明显低于非甲减组，梭菌、类酵母菌增多，双歧杆菌、乳杆菌减少，差异有统计学意义(P<0.05)；但甲减组与非甲减组革兰阴性杆菌、革兰阳性杆菌、变形杆菌、拟杆菌属比较，差异无统计学意义(P>0.05)。Logistic回归分析显示,肠道菌群失调、年龄≥30岁、孕周≥30周、妊娠期高血压、妊娠期糖尿病均是妊娠期甲状腺功能减退的危险因素(P<0.05)。结论： 肠道菌群失调会增加妊娠期甲状腺功能减退发生风险。

Objective:To explore the relationship between intestinal flora and hypothyroidism during pregnancy. Methods:466 pregnant women who underwent routine check-ups in our hospital from July 2019 to April 2021 were selected as the research objects. According to the diagnosis of intestinal flora, they were divided into intestinal flora imbalance group(n=85) and normal intestinal flora group(n=381). By detecting the serum thyroid-stimulating hormone(TSH) and free thyroxine(FT4) levels in the two groups, the occurrence of hypothyroidism was determined and then compared during pregnancy between the two groups.The pregnant women were divided into hypothyroidism group and non-hypothyroidism group according to whether the pregnant women had hypothyroidism. The distribution of intestinal flora in pregnant women with hypothyroidism and non-hypothyroidism was observed. A multivariate logistic regression model was used to test the relationship between intestinal flora and hypothyroidism during pregnancy. Results: The incidence of hypothyroidism in pregnancy was 34.12% in the dysbacteriosis group, which was significantly higher than that in the normal group 4.72%, (χ²=66.208, P<0.001). The total intestinal microflora of pregnant women in hypothyroidism group was significantly lower than that in non hypothyroidism group, the number of Clostridium and yeast like bacteria was more than that in non hypothyroidism group, and the number of Bifidobacterium and Lactobacillus was less than that in non hypothyroidism group(P<0.05). However, there was no significant difference in Gram-negative bacilli, Gram-positive bacilli, Proteus and Bacteroides between hypothyroidism group and non hypothyroidism group(P>0.05). Logistic regression analysis showed that: dysbacteriosis of intestinal flora, age≥30 years old, gestational age≥30 weeks, gestational hypertension and gestational diabetes were all risk factors of hypothyroidism during pregnancy(P<0.05).Conclusion:Intestinal flora imbalance can increase the risk of hypothyroidism during pregnancy.

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