Analiza parametara glikoregulacije, liporegulacije i parametara funkcije štitaste žlezde tokom trudnoće

Abstract

Trudnoća predstavlja stanje rezistencije na insulin koja u ne kih žena može da predisponira razvoj dijabetesa, koji je udružen sa povećanim rizikom i po majku i po plod. Tokom trudnoće su česti i poremećaji tiroidne funkcije, posebno autoimunska tiroidna bolest (AITB) i hipotiroidizam. Osnovni cilj istra živanja je analiza pa rametara glikoregulacije, liporegulacije i parametara funkcije štitaste žlezde tokom trudnoće. Istraživanje predstavlja kliničku, opservacionu, neinterventnu, analitičku, prospektivnu, kohortnu studiju, sprovedene u jednom centru. Osnovni kriterijum i za uključivanje pacijenata u studiju su bili: ženski pol, starost iznad 18 godina i postavljena dijagnoza vitalne i željene trudnoće u prvom trimestru. Protokol istraživanja je podrazumevao da ono bude obavljeno tokom četiri posete pa cijentkinja (u 1., 2. i 3. trimestru trudnoće, kao i četiri nedelje posle porođaja): OGTT sa 100g glukoze, sa određivanjem glikemije i insulinemije u 0, 60, 120 i 180 minutu, HbA1c, parametri funkcije štitaste žlezde (fT4, fT3, TSH, antiTG antitela, antiTPO antitela, kalcitonin), standardne laboratorijske analize, lipidogram (tHol, HDL, LDL, TAG. U dalje istraživanje su uključe ne samo pacijentkinje koje su imale sve uključujuće i ni jedan isključujući kriterijum. Na osnovu rezultata OGTT stratifikovali smo ispitanice u tri grupe: normalna tolerancija glukoze (NTG), minimalni poremećaj glikoregulacije (MPG) i gestacijski dijabetes melitus (GDM), odnosno u dve grupe : normalna tolerancija glukoze (NTG) i patološka tolerancija glukoze (PTG=MPG+G DM).

Pregnancy presents a state of insulin resistance that can predipose diabetes development in some women, and is associated with increased risk for neonate and for mother. During pregnancy are often thyroid disorders, especially autoimmune thyroid disease (AITD) and hypothyreoidism. The main goal of the research was analysis of parameters glicoregulation, liporegulation and thyroid function during pregnancy. This research presents clinical, observational, noninterventional, analytic, prospective, cohort study, conducted in one center. Inclusion criteria were: female gender, older than 18 years and diagnosis of vital and desired pregnancy in the first trimester. Study protocol imply that it should be done during four visits (1st, 2nd and 3rd trimester, and 4 weeks after delivery): ОGТТ with 100 g glucose, with specifying glicemia and insulinemia in 0. , 60. , 120. and 180. minutes and HbA1c, thyroid function parameters (fТ4, fТ3, ТSH, antiТG antibodies, antiТPO аntibodies, calcitonin), standard laboratory analysis, lipids (tHol, HDL, LDL, TAG). According to OGTT results we divided patients in three groups : normal glucose tolerance (NGT), minimal disorder of glicoregulation (МDG) and gestational diabetes mellitus (GDM), respectively in two groups : normal glucose tolerance and pathologic glucose tolerance (PTG=MDG+GDM). The research included 92 pregnant women with diagnosis of vital and desired pregnancy in the first trimester, while 77 finished examination. Patients were average 30,8±4,7 (19-41) years old. It was shown that there was impact the number of risk factors on degree of glucose tolerance disorder (р=0,034), while most of patients had no risk factor (48%). From 77 patients, the 9 was with GDM, 9 was with MPG (18 with PTG). As pregnancy progress, disorder of glucose tolerance increased (in 2nd and 3rd trimester), while four weeks after delivery all were with NTG. The average insulinemia during pregnancy is the greatest in 1st and 2nd trimester in MDG group in 60. and 120. minute, in GDM group in 120. minute, during 3rd trimester greatest in 0. and 60. minute in MDG group, while in 120. and 180. minute greatest in GDM group. The average insulinemia during pregnancy is significantly great in PTG.