摘要
目的 探讨孕早期母体血清白介素(IL)-33、可溶性肿瘤抑制素2(sST2)水平及其比值与妊娠期糖尿病(GDM)的相关性。方法 选择2017年4月至2020年12月期间在赤峰市医院早孕门诊于孕8~12周建档并定期产检的244例孕妇为研究对象;根据孕24~28周时75g口服葡萄糖耐量试验(OGTT)结果将其分为GDM组(n=40)和正常葡萄糖耐量(NGT)组(n=204),比较两组间孕早期(孕8~12周)的临床资料、血清IL-33和sST2水平、IL-33/sST2比值的差异。采用Pearson分析IL-33、sST2水平及其比值与OGTT时空腹血糖(FPG)、胰岛素抵抗指数(HOMA-IR)的相关性,采用Logistic回归模型分析GDM的影响因素,采用受试者工作特征(ROC)曲线分析孕早期IL-33水平及IL-33/sST2比值对GDM的预测价值。结果 GDM组孕妇的年龄、孕前体质量指数、孕早期增重,以及血红蛋白(Hb)、红细胞计数、白细胞计数、甘油三酯、总胆固醇(TC)、γ-谷氨酰基转移酶、碱性磷酸酶、IL-33、sST2水平均显著高于NGT组,IL-33/sST2比值低于NGT组,差异均有统计学意义(t=2.064~4.829、U=4.582,P<0.05)。GDM组孕早期血清IL-33水平及IL-33/sST2比值与孕中期OGTT时的FPG、HOMA-IR均呈负相关(r分别为-0.434、-0.391、-0.546、-0.534,P<0.001),孕早期血清sST2水平与孕中期OGTT时的FPG、HOMA-IR均呈正相关(r分别为0.373、0.343,P<0.05)。Logistic回归分析显示:IL-33、IL-33/sST2、Hb、TC均是发生GDM的影响因素(Waldχ^(2)值分别为14.551、14.039、5.678、7.072,P<0.05)。ROC曲线分析显示:IL-33、IL-33/sST2单一指标及回归方程联合指标均对GDM具有预测价值,联合指标的预测效能优于单一指标,灵敏度和特异度分别为80.00%和88.73%。结论 GDM孕早期母体血清IL-33水平增加、IL-33/sST2比值降低,推测IL-33代偿性分泌不足与GDM发病有关,联合使用IL-33、IL-33/sST2、Hb、TC具有较好地预测GDM的价值。
Objective To study the correlation between maternal serum interleukin(IL)-33,soluble suppression of tumorigenicity 2(sST2) contents and its ratio in early pregnancy and gestational diabetes mellitus(GDM).Methods A total of 244 pregnant women who visited the early pregnancy clinic of Chifeng Municipal Hospital at 8-12 weeks of gestation from April 2017 to December 2020 and conducted regular obstetric visits were selected as the study subjects.They were divided into the GDM group(n=40) and the normal glucose tolerance(NGT) group(n=204) according to the results of oral glucose tolerance test(OGTT) at 24-28 weeks of gestation.The differences of clinical data, serum IL-33 and sST2 contents and IL-33/sST2 ratio of early pregnancy(8-12 weeks of gestation) between the two groups were compared.The correlation between the serum IL-33,sST2 contents and its ratio and fasting plasma glucose(FPG),homeostatic model assessment for insulin resistance(HOMA-IR) at OGTT were analyzed by Pearson test.The influencing factors of GDM were analyzed by Logistic regression model, and the predictive value of IL-33 level and IL-33/sST2 ratio in early pregnancy on GDM was analyzed by receiver operating characteristic(ROC) curve.Results Age, pre-pregnancy body mass index, weight gain in early pregnancy, hemoglobin(Hb),red blood cell count, white blood cell count, triglyceride, total cholesterol(TC),γ-glutamyltransferase, alkaline phosphatase, IL-33 and sST2 in the GDM group were higher than those in the NGT group, and the ratio of IL-33/sST2 was lower than that in the NGT group(t=2.064-4.829,respectively, U=4.582,P<0.05).In the GDM group, the content of serum IL-33 and the ratio of IL-33/sST2 were negatively correlated with FPG and HOMA-IR at OGTT during the second trimester of pregnancy(r=-0.434,-0.391,-0.546 and-0.534,respectively, P<0.001),and the content of sST2 of early pregnancy was positively correlated with FPG and HOMA-IR at OGTT during the second trimester of pregnancy(r=0.373 and 0.343,respectively, P<0.05).Logistic regression analysis showed that IL-33,IL-33/sST2,Hb and TC were the influencing factors of GDM(Waldχ^(2)=14.551,14.039,5.678 and 7.072,respectively, P<0.05).ROC curve analysis showed that IL-33,IL-33/sST2 single index and the combined index of regression equation had predictive value for GDM.The predictive efficiency of the combined index was better than that of the single index, and the sensitivity and specificity were 80.00% and 88.73%,respectively.Conclusion The content of serum IL-33 increased and the ratio of IL-33/sST2 decreased in the first trimester of GDM patients.It is speculated that the insufficient compensatory secretion of IL-33 is related to the pathogenesis of GDM.The combined use of IL-33,IL-33/sST2,Hb and TC has a good predictive value of GDM.
作者
李秀娟
张林林
于志娟
LI Xiujuan;ZHANG Linlin;YU Zhijuan(Department of Obstetrics,Chifeng Municipal Hospital,Inner Mongolia Chi feng 024000,China;Department of Obstetrics,Ar Horqin Banner Maternal and Child Health Family Planning Service Center,Inner Mongolia Chi feng 025550,China)
出处
《中国妇幼健康研究》
2022年第9期57-63,共7页
Chinese Journal of Woman and Child Health Research
基金
赤峰市自然科学科研项目(SZR21206)。
关键词
妊娠期糖尿病
白介素-33
可溶性肿瘤抑制素2
预测
gestational diabetes mellitus
interleukin-33
soluble suppression of tumorigenicity 2
prediction
