摘要
目的：探讨妊娠期糖尿病（GDM）患者孕早期肿瘤坏死因子α（TNF-α）、性激素结合球蛋白（SHBG）与胰岛素抵抗的关系及对妊娠结局进行研究。方法选择395例孕15周前妇女留取空腹静脉血和血浆，随访至24～28周进行75 g口服葡萄糖耐量试验。测定孕妇孕早期TNF-α、SHBG及HOMA-IR水平。结果（1）395例孕妇中有65例（16.5%）诊断为GDM。（2）孕早期， GDM孕妇的TNF-α、HOMA-IR均显著高于正常孕妇（P＜0.01）；而GDM孕妇的SHBG显著低于正常孕妇（P＜0.01）。Pearson分析显示，GDM组TNF-α、SHBG均与HOMA-IR呈正相关；正常孕妇的TNF-α、SHBG均与HOMA-IR不相关。（3）GDM妊娠的不良妊娠结局显著高于正常妊娠。（4）单项检测TNF-α的灵敏度为69.2%，特异度为75.5%；单项检测SHBG的灵敏度为70.8%，特异度为40.3%。TNF-α与SHBG联合检测，灵敏度和特异度分别为92.3%、93.0%。结论 TNF-α、SHBG对于早期预测GDM有非常重要的作用。联合TNF-α和SHBG检测可提高诊断GDM的灵敏度和特异度。
Objective To explore the change of blood TNF-α, SHBG and their relationship with insulin resistance in pregnant women in their first trimester. Methods Observational study included 395 pregnant women. Maternal tumor necrosis factor-α（TNF-α）, serum sex hormone binding globulin and insulin resistance index （HOMA-IR） were measured before 15 weeks of gestation. Patients were followed-up to 24-28 gestation each woman who underwent 75 g OGTT. Results There were 65 （16.5%） diagnosed as gestational diabetes mellitus （GDM）. TNF-αand HOMA-IR levels were significantly higher, but SHBG levels were significantly lower among women who subsequently developed GDM compared with normal pregnant woman. TNF-αand SHBG levels in GDM were positively correlated with the level of HOMA-IR, but not in normal pregnant woman. Adverse pregnancy outcomes of GDM were significantly higher than normal pregnant woman. For prediction of GDM, TNF-α at a cutoff value of 1.725 showed a sensitivity and a specificity of 69.2%and 75.5%, respectively. SHBG at a cutoff value of 213.4 nmol/L showed a sensitivity and a specificity of 70.8% and 40.3%, respectively. Low SHBG with high TNF-αpredicted GDM with a sensitivity and specificity of 92.3%and 93.0%. Conclusion TNF-αand SHBG are important early predictor of GDM. Adding SHBG to TNF-α improves specificity and respectively.
出处
《中华临床医师杂志（电子版）》
CAS
2014年第20期11-14,共4页
Chinese Journal of Clinicians(Electronic Edition)
