孕期不同甲状腺功能状态血清高密度脂蛋白胆固醇和载脂蛋白A-Ⅰ的变化趋势
Variation tendency in serum high density lipoprotein cholesterol and apolipopro-tein A-Ⅰ in different thyroid function status during pregnancy

目的：研究不同甲状腺功能状态对孕妇血清高密度脂蛋白胆固醇（high density cholesterol, HDL-C）和载脂蛋白A-Ⅰ（apolipoprotein A-Ⅰ, ApoA-Ⅰ）代谢的影响。方法：采集30名甲状腺功能正常（正常组）、19名亚临床甲状腺功能减退（亚甲减组）及8名亚临床甲状腺功能亢进（亚甲亢组）孕妇孕9~12、 14~17、 23~26和37~40周的空腹血清标本，测其血清HDL-C和ApoA-Ⅰ含量。采用重复测量数据方差分析的秩和检验分析4个妊娠时段孕妇血清HDL-C、ApoA-Ⅰ含量的变化；采用一般线性模型(general linear model, GLM)分析3组孕妇孕期血清HDL-C、ApoA-Ⅰ含量的差异。结果：孕期各组孕妇血清HDL-C含量的变化差异均无统计学意义（χ2=5.428，P=0.143； χ2=2.027，P=0.567； χ2=2.885，P=0.410），正常孕妇和亚甲减孕妇血清ApoA-Ⅰ的含量增高，差异均有统计学意义（χ2=46.343，P＜0.001； χ2=35.984，P＜0.001），亚甲亢孕妇血清ApoA-Ⅰ含量的变化差异无统计学意义（χ2=6.750，P=0.080）。亚甲亢孕妇孕期血清HDL-C和ApoA-Ⅰ的含量均低于正常孕妇，差异均有统计学意义（P=0.025，P=0.027），正常孕妇与亚甲减孕妇孕期血清HDL-C和ApoA-Ⅰ含量的差异均无统计学意义（P =0.378，P =0.549）。结论：妊娠期亚甲亢影响孕妇血清HDL-C和ApoA-Ⅰ代谢，进而影响胎儿的生长发育；妊娠期亚甲减（经优甲乐治疗后）未发现影响孕妇血清HDL-C和ApoA-Ⅰ代谢。
Objective：To study the metabolism of high density lipoprotein cholesterol (HDL-C) and apolipoprotein A-Ⅰ (ApoA-Ⅰ) in different thyroid function status during pregnancy. Methods:This study recruited thirty cases of euthyroid, with nineteen cases of subclinical hypothyroid and eight cases of subclinical hyperthyroid pregnancy. The concentrations of fasting serum HDL-C and ApoA-Ⅰ were detected and analyzed from 9-12, 14-17, 23-26, and 37-40 gestational weeks. Friedman repeated measures ANOVA on ranks was adopted to analyze the changes of serum HDL-C and ApoA-Ⅰ at different stages. General linear model (GLM) was adopted to analyze the differences of serum HDL-C and ApoA-Ⅰ in different thyroid function status during pregnancy.Results:There were no significant differences of maternal serum HDL-C among different stages (χ2=5.428，P=0.143, χ2=2.027，P=0.567, χ2=2.885，P=0.410). There were significant differences of serum ApoA-Ⅰ during euthyroid and subclinical hypothyroid pregnancies (χ2=46.343， P＜0.001, χ2=35.984， P＜0.001), and no significant difference during subclinical hyperthyroid pregnancy (χ2=6.750， P=0.080). There were significant differences of serum HDL-C and ApoA-Ⅰ between euthyroid and subclinical hyperthyroid pregnancies (P=0.025，P=0.027), and no significant differences between euthyroid and subclinical hypothyroid pregnancies (P=0.378，P=0.549). Conclusion:Subclinical hyperthyroidism affected the metabolism of maternal serum HDL-C and ApoA-Ⅰ, which could affect the fetal growth and development. Subclinical hypothyroidism (after treatment with drugs) had no obvious effect on the metabolism of maternal serum HDL-C and ApoA-Ⅰ.