摘要
目的探讨血清D-二聚体(D-D)、脂蛋白a(Lpa)与妊娠期代谢综合征(GMS)的相关性。方法回顾性选取2018年1月至2020年5月成都市妇女儿童中心医院收治的130例GMS患者作为观察组,另外选取同期于本院产检的正常妊娠妇女130例作为对照组。收集两组年龄、采血孕周、孕前体重指数(BMI)、收缩压、舒张压、空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)等基线资料,采用酶联免疫吸附试验法(ELISA)检测血清D-D、Lpa表达水平,并进行组间比较;采用Pearson分析观察组血清D-D、Lpa表达水平与基线资料相关性;绘制受试者工作特征(ROC)曲线评估血清D-D、Lpa对GMS的诊断价值;采用多因素Logistic回归模型分析影响孕妇发生GMS的危险因素。结果与对照组相比,观察组孕前BMI、FBG、收缩压、舒张压、TC、TG、LDL-C、D-D、Lpa较高(P<0.05),HDL-C较低(P<0.05);Pearson分析结果显示,观察组血清D-D、Lpa表达水平与孕前BMI、FBG、收缩压、TC、TG、LDL-C呈正相关(P<0.05),与HDL-C呈负相关(P<0.05);血清D-D、Lpa单独诊断GMS的曲线下面积(AUC)分别为0.806、0.808,对应的截断值分别为1817.63μg/L、323.34 mg/L,敏感度分别为79.20%、70.80%,特异度分别为73.80%、89.20%,两者联合诊断GMS的AUC为0.877,敏感度、特异度分别为86.90%、76.90%,与血清D-D、Lpa单独诊断相比,两者联合诊断敏感度较高;孕前BMI≥25 kg/m^(2)、GDM、妊娠期高血压、TG≥3.23 mmol/L、LDL-C高表达、D-D高表达、Lpa高表达是孕妇发生GMS的独立危险因素(P<0.05)。结论GMS患者血清D-D、Lpa为高表达,均是GMS发生的独立危险因素,可能成为早期诊断GMS的血清学指标。
Objective To investigate the relationship between serum D-dimer(D-D),lipoprotein a(Lpa)and gestational metabolic syndrome(GMS).Methods A total of 130 patients with GMS in our hospital from January 2018 to May 2020 were selected as the observation group,in addition,130 cases of normal pregnant women in our hospital during the same period were selected as the control group.The baseline data of age,gestational weeks at the time of blood collection,pre-pregnancy body mass index(BMI),systolic blood pressure,diastolic blood pressure,fasting blood glucose(FBG),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)were collected,enzyme linked immunosorbent assay(ELISA)was used to detect the expression levels of serum D-D and Lpa,and they were compared between the two groups;Pearson analysis was used to analyze the correlation between the expression levels of serum D-D and Lpa and the baseline data;receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of serum D-D and Lpa for GMS;multivariate Logistic regression model was used to analyze the risk factors of GMS in pregnant women.Results Compared with those in the control group,pre-pregnancy BMI,FBG,systolic blood pressure,diastolic blood pressure,TC,TG,LDL-C,D-D and Lpa were higher in the observation group(P<0.05),while HDL-C was lower(P<0.05);pearson analysis showed that the expression levels of serum D-D and Lpa were positively correlated with pre-pregnancy BMI,FBG,systolic blood pressure,TC,TG,LDL-C(P<0.05),and negatively correlated with HDL-C(P<0.05);the area under the curve(AUC)of serum D-D and Lpa in the diagnosis of GMS was 0.806 and 0.808 respectively,the corresponding cut-off value was 1817.63μg/L and 323.34 mg/L,respectively,the sensitivity was 79.20%,70.80%,and the specificity was 73.80%and 89.20%,respectively,the AUC of combined diagnosis was 0.877,the sensitivity and specificity were 86.90%and 76.90%,respectively,compared with the single diagnosis of serum D-D and Lpa,the combined diagnosis of GMS had higher sensitivity;BMI≥25 kg/m^(2),GDM,gestational hypertension,TG≥3.23 mmol/L,high expression of LDL-C,high expression of D-D and high expression of Lpa were independent risk factors of GMS in pregnant women(P<0.05).Conclusion Serum D-D and Lpa are highly expressed in patients with GMS,and they are independent risk factors of GMS,which may be used as serological indicators for early diagnosis of GMS.
作者
熊敏
赖繁
葛会生
汤蓉
XIONG Min;LAI Fan;GE Hui-sheng(Department of Obstetrics and Gynecology,Women and Children's Hospital Affiliated to School of Medicine,University of Electronic Science and Technology of China,Chengdu Women and Children's Central Hospital,Chengdu Sichuan 611731,China.)
出处
《临床和实验医学杂志》
2021年第18期1987-1990,共4页
Journal of Clinical and Experimental Medicine
基金
2020年四川省卫生健康委员会科研项目(编号:20PJ184)。
