摘要
目的探讨联合检测白细胞参数、白细胞介素-22(interleukin-22,IL-22)及脂蛋白相关磷脂酶A2(lipoprotein associated phospholipase A2,Lp-PLA2)对妊娠期糖尿病(gestational diabetes mellitus,GDM)的临床意义。方法选取2018年1月至2020年6月在廊坊市第四人民医院产前检查的孕妇106例,根据孕中期(24~28周)的口服糖耐量试验(oral glucose tolerance test,OGTT)结果分为观察组60例(血糖升高)和对照组46例(血糖正常)。收集2组孕妇年龄、孕前体重指数(body mass index,BMI)、血糖、血脂、稳态模型评估胰岛素抵抗指数(homeostasis model assessment-insulin resistance,HOMA-IR)等临床资料。比较两组孕早期(11~14周)白细胞计数(white blood cell count,WBC)、中性粒细胞百分比(percentage of neutrophils,Neut%)、淋巴细胞百分比(percentage of lymphocytes,LY%)、中性粒细胞计数与淋巴细胞计数的比值(the ratio of neutrophil count to lymphocyte count,NLR)、IL-22、LP-PLA2水平。使用Logistic回归法筛选GDM的危险因素。使用Logistic相关分析法分析相关指标与HOMA-IR的线性相关性。使用Pearson曲线分析相关指标对GDM的预测效力。结果观察组空腹血糖、服糖1 h后血糖、服糖2 h后血糖,TG,HOMA-IR、WBC、NLR、Lp-PLA2高于对照组,IL-22低于对照组(P<0.05)。Logistic分析结果显示,WBC、NLR、IL-22、Lp-PLA2为GDM发生的独立影响因素(P<0.05)。WBC、NLR、Lp-PLA2水平与HOMA-IR呈正相关(r=0.69,0.70,0.72,P<0.05),IL-22与HOMA-IR呈负相关(r=0.84,0.80,P<0.05)。WBC、NLR、IL-22、Lp-PLA2诊断GDM的最佳Cut-off值分别为≥9.23×10^(9)/L、≥4.06、≤7.68 pg/mL、≥230.96 ng/mL,单独诊断GDM的AUC分别为0.634、0.705、0.733、0.759,4项指标联合诊断的AUC为0.861,高于单一指标诊断的AUC。结论孕早期WBC、NLR、IL-22、Lp-PLA2水平与GDM的发生有关,联合检测有助于提高诊断的准确性。
Objective To discuss the clinical significance of combined detection of leucocyte parameter,interleukin-22(IL-22)and lipoprotein associated phospholipase A2(Lp-PLA2)in gestational diabetes mellitus(GDM).Methods Atotal of 106 pregnant women who received prenatal examination in Fourth People s Hospital of Langfang from January 2018 to June 2020 were selected.According to the results of oral glucose tolerance test(OGTT)in the second trimester(24-28 weeks),they were divided into an observation group(60 cases with elevated blood glucose)and a control group(46 cases with normal blood glucose).Clinical data including age,pre-pregnancy body mass index(BMI),blood glucose,blood lipid and homeostasis model assessment insulin resistance(HOMA-IR)were collected.WBC,percentage of neutrophils(Neut%),percentage of lymphocytes(LY%),ratio of neutrophils to lymphocytes(NLR),IL-22 and Lp-PLA2 levels during early pregnancy(11-14 weeks)were compared between the 2 groups.Logistic regression was used to screen the risk factors of GDM.Pearson correlation analysis was used to analyze the linear correlation between related indicators and HOMA-IR.ROC curve was used to analyze the predictive effect of relevant indicators on GDM.Results Fasting blood glucose,blood glucose after 1h,blood glucose after 2h of glucose consumption,blood glucose,TG,HOMA-IR,WBC,NLR,and LP-PLA2 in the observation group were higher than those in the control group,and IL-22 was lower than that in control group(P<0.05).Logistic analysis showed that WBC,NLR,IL-22 and LP-PLA2 were independent influencing factors of GDM occurrence(P<0.05).The levels of WBC,NLR,and LP-PLA2 were positively correlated with HOMA-IR(r=0.69,0.70,0.72,P<0.05),and IL-22 was negatively correlated with HOMA-IR(r=0.84,0.80,P<0.05).The optimal cut-off values of WBC,NLR,IL-22,and LP-PLA2 in diagnosis of GDM were≥9.23×10^(9)/L,≥4.06,≤7.68 pg/mL,≥230.96 ng/mL,respectively.The AUC of single diagnosis of GDM was 0.634,0.705,0.733,0.759,respectively.The AUC of combined diagnosis of four indicators was 0.861,which was higher than that of single indicator diagnosis.Conclusion The levels of WBC,NLR,IL-22,and LP-PLA2 in early gestation are correlated with the occurrence of GDM,and the combined detection is helpful to improve the accuracy of diagnosis.
作者
李晶
徐燕
LI Jing;XU Yan(Fourth People's Hospital of Langfang, Langfang 065700, China)
出处
《邵阳学院学报（自然科学版）》
2022年第3期110-116,共7页
Journal of Shaoyang University：Natural Science Edition
