| Gestational diabetes(GDM)is a metabolic disease that occurs for the first time during pregnancy and has elevated levels of glucose metabolism.At present,the body’s resistance to insulin,impaired use of insulin,and dysfunction in β-cell secretion of insulin are the main causes of GDM.Thyroid peroxidase antibody(TPOAb)is one of the characteristic antibodies of autoimmune thyroid disease(AITD).Almost all patients with Hashimoto’s thyroiditis and two-thirds of postpartum thyroiditis TPOAb exists in patients and 75% of patients with Graves(graves disease,GD)hyperthyroidism.TPOAb is mainly produced by lymphocyte infiltration in the thyroid,and a small part is produced by local lymph nodes or bone marrow.TPOAb has antibody-dependent cell-mediated cytotoxicity.Bone metabolism indicators are metabolites formed in the process of bone transformation.More and more evidences show that there is an interaction between bone metabolism and glucose metabolism and the immune system.Studies have shown that both GDM and AITD affect the level of bone metabolism in pregnant women.The incidence of postpartum osteoporosis(OP)in GDM patients is significantly increased,and positive TPOAb is a high risk factor for fractures.GDM with TPOAb positive can increase the incidence of pregnancy loss,premature delivery,and placental abruption.Objective:This article aims to observe the changes in bone metabolism-related indicators in patients with GDM and TPOAb positive,to prevent bone metabolism diseases in patients with GDM and TPOAb positive,and to reduce the risk of adverse pregnancy outcomes.Methods:In the autumn and winter of 2018-2020,50 cases of pregnant women diagnosed with GDM and TPOAb positive were selected as group A,50 cases of pregnant women diagnosed with GDM and TPOAb negative were classified as group B,and 50 pregnant women with TPOAb positive and normal blood glucose levels The example is group C.In order to exclude the influence of sunshine factors,50 healthy pregnant women who were examined in our hospital during the same period were selected as group D(control group)according to the enrollment months of patients in groups A,B,and C.Detection of bone metabolism related indicators of four groups of pregnant women:25-OHVitamin D[25-OHVitamin D,25-(OH)D)],parathyroid hormone(PTH),osteocalcin(BGP),calcitonin(calcitonin,CT),total type I collagen amino terminal elongation peptide(PINP),β-collagen special sequence(β-CTX),related to bone metabolism in four groups of pregnant women The indicators were analyzed statistically to compare whether there were differences in the bone metabolism levels of the four groups of pregnant women.Analyze the correlation between blood glucose and TPOAb and bone metabolism indicators.Results:1.General information comparisonThere was no significant difference in age(Age),gestational age(GA),body mass index(BMI),TSH,FT3,and FT4 levels in the four groups(P>0.05).See attached table 1.2.Comparison of blood glucose,thyroid function,TPOAb indexThe TPOAb level of group A was [372.27(260.41,502.83)]significantly higher than that of group B [2.53(1.30,3.76)],the difference was statistically significant(P<0.05),the two groups were OGTT FBG,PG-1h,PG-2h There was no statistically significant difference in the levels of Hb Alc and Hb Alc(P>0.05).See attached table 2.The levels of OGTT FBG,PG-1h,PG-2h,and Hb Alc in group A were[5.50(5.30,5.73),8.75(7.30,9.45),7.70(6.70,8.80),5.20(5.30,5.45)]significantly higher than C Group [4.80(4.70,4.90),7.80(7.10,8.30),6.80(6.40,7.60),4.80(4.70,4.90)],the difference was statistically significant(P<0.05),there was no significant difference in TPOAb levels between the two groups Significance(P>0.05).See attached table 2.The levels of OGTT FBG,PG-1h,PG-2h,and Hb Alc in group B were[5.40(5.20,5.63),8.40(7.28,9.93),7.80(6.80,8.80),5.25(5.15,5.35)]significantly higher than D The groups were [4.80(4.60,4.90),7.70(7.00,8.20),6.60(6.28,7.40),4.76(4.70,4.81)],the difference was statistically significant(P<0.05),there was no difference in TPOAb levels between the two groups Statistically significant(P>0.05).See attached table 2.The level of TPOAb in group C was [352.27(240.41,482.83)] was significantly higher than that in group D [2.67(1.50,3.93)],the difference was statistically significant(P<0.05),the two groups were OGTT FBG,PG-1h,PG-2h There was no statistically significant difference in the levels of Hb Alc and Hb Alc(P>0.05).See attached table 2.3.Comparison of bone metabolism markersThe 25-(OH)D level of group A was(19.89±4.50)lower than that of group B(22.88±4.54),and the difference was statistically significant(P<0.05).The levels of PTH,BGP,β-CTX,and PINP in group A were in order [ 49.18±15.15,18.67±6.50,0.39(0.31,0.48),38.53±7.80] are higher than group B [40.04±11.64,15.67±6.50,0.31(0.21,0.40),33.24±7.63],the difference is statistically significant(P<0.05).See attached table 3.The level of 25-(OH)D in group A was(19.89±4.50)lower than that of group C(25.47±4.39),and the difference was statistically significant(P<0.05).The levels of PTH,BGP,and β-CTX in group A were[49.18±15.15,18.67±6.50,0.39(0.31,0.40)] were higher than group C[32.24±9.80,15.80±6.45,0.30(0.20,0.40)],the difference was statistically significant(P<0.05).There was no statistically significant difference in PINP levels between the two groups(P>0.05).See attached table 3.The 25-(OH)D level of group B was(22.88±4.54)lower than that of group D(28.50±4.26),and the difference was statistically significant(P<0.05).The levels of PTH,BGP,and β-CTX in group B were [40.04±11.64,15.67±6.50,0.31(0.21,0.40)] were higher than group D [25.90±10.50,12.90±6.24,0.22(0.12,0.32)],the difference was statistically significant(P<0.05).There was no statistically significant difference in PINP levels between the two groups(P>0.05).See attached table 3.The level of 25-(OH)D in group C was(25.47±4.39)lower than that in group D(28.50±4.26),the difference was statistically significant(P<0.05),the levels of PTH,BGP,β-CTX,and PINP in group C were in order[ 32.24±9.80,15.80±6.45,0.30(0.20,0.40),37.49±7.62] are higher than group D [25.90±10.50,12.90±6.24,0.22(0.12,0.32),32.32±7.44],the difference is statistically significant(P<0.05).See attached table 3.4.Spearman correlation analysis was performed.The results showed that TPOAb levels were negatively correlated with 25-(OH)D levels in patients diagnosed with GDM,and positively correlated with PTH,BGP,PINP,and β-CTX levels(P<0.05).CT has no correlation(P>0.05).See attached table 4.5.The spearman correlation analysis showed that in patients with TPOAb positive,FBG levels were negatively correlated with 25-(OH)D levels,and positively correlated with BGP,PTH,and β-CTX levels(P <0.05),and PINP,CT correlation is not obvious.PG-1h and PG-2h are positively correlated with β-CTX,but have no obvious correlation with other bone metabolism markers.(P>0.05).See attached table 5.Conclusion:1.Patients with gestational diabetes mellitus with positive thyroid peroxidase antibody have reduced vitamin D levels,increased bone formation and bone resorption and metabolism,and increased bone turnover levels,which are related to thyroid peroxidase antibodies and blood sugar levels.2.Thyroid peroxidase antibody affects the bone metabolism indexes of patients with gestational diabetes.The higher the level of thyroid peroxidase antibody,the lower the vitamin D level,the higher the level of bone formation and bone absorption metabolism index.3.Blood glucose affects the bone metabolism of patients with positive thyroid peroxidase antibody.The higher the fasting blood glucose level,the lower the vitamin D level,and the higher the level of osteocalcin,parathyroid hormone and β-collagen special sequence;1h after taking sugar The higher the blood sugar level,the higher the blood sugar level 2h after taking sugar,the higher the level of β-collagen special sequence. |
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