摘要
目的分析妊娠期糖尿病(GDM)患者血清神经降压素相关肽(Xenin-25)、C1q肿瘤坏死因子相关蛋白12(CTRP12)与妊娠结局的关系。方法选取2021年2月—2022年2月川北医学院附属医院生殖医学科诊治的GDM患者92例为GDM组,再根据是否发生不良妊娠结局,分为预后不良亚组(n=34)和预后良好亚组(n=58)。以同期健康妊娠妇女50例为正常妊娠组。采用酶联免疫吸附法检测血清Xenin-25、CTRP12水平;Pearson相关性分析血清Xenin-25、CTRP12与糖代谢指标的相关性;多因素Logistic回归分析影响GDM患者不良妊娠结局的因素;受试者工作特征曲线评价血清Xenin-25、CTRP12对妊娠结局的预测价值。结果GDM组血清Xenin-25、CTRP12低于正常妊娠组,而空腹血糖(FPG)、糖化血红蛋白(HbA_(1c))、空腹胰岛素(FINS)及稳态模型评估的胰岛素抵抗指数(HOMA-IR)水平均高于正常妊娠组(t/P=16.046/<0.001,22.114/<0.001,11.510/<0.001,13.666/<0.001,12.101/<0.001,14.413/<0.001);GDM组血清Xenin-25、CTRP12表达与FPG、FINS、HbA_(1c)及HOMA-IR呈显著负相关(Xenin-25:r/P=-0.665/<0.001,-0.598/<0.001,-0.567/<0.001,-0.702/<0.001;CTRP12:r/P=-0.579/<0.001,-0.622/<0.001,-0.667/<0.001,-0.725/<0.001);预后不良亚组血清Xenin-25、CTRP12低于预后良好亚组,HOMA-IR高于预后良好亚组(t/P=6.783/<0.001,17.997/<0.001,15.146/<0.001);血清CTRP12升高、Xenin-25升高是影响GDM患者不良妊娠结局的独立保护因素[OR(95%CI)=0.646(0.499~0.837),0.619(0.465~0.824)],HOMA-IR升高是危险因素[OR(95%CI)=1.353(1.110~1.649)]。血清Xenin-25、CTRP12及二者联合预测GDM患者不良妊娠结局的AUC分别为0.828、0.815、0.870,二者联合优于各自单独预测效能(Z=4.113、4.327,P=0.003、0.001)。结论GDM孕妇血清Xenin-25、CTRP12水平降低,均参与GDM的疾病过程,二者联合对GDM患者不良妊娠结局具有较高的评估价值。
Objective To analyze the relationship between serum neurotensin related peptide(Xenin-25),complement C1 tumor necrosis factor related protein 12(CTRP12)and pregnancy outcome in patients with gestational diabetes mellitus(GDM).Methods Ninety-two GDM patients diagnosed and treated in the Reproductive Medicine Department of the Affiliated Hospital of North Sichuan Medical College from February 2021 to February 2022 were selected as the GDM group.According to the presence or absence of adverse pregnancy outcomes,they were divided into poor prognosis subgroup(n=34)and good prognosis subgroup(n=58).A total of 50 healthy pregnant women in the same period were enrolled as the normal pregnancy group.Serum Xenin-25 and CTRP12 were detected by enzyme-linked immunosorbent assay.Pearson correlation analysis was used to analyze the correlation between serum Xenin-25,CTRP12 and glucose metabolism indexes.Multivariate Logistic regression was used to analyze the factors affecting adverse pregnancy outcomes in GBM patients.Receiver operating characteristic curve was used to evaluate the predictive value of serum Xenin-25 and CTRP12 for pregnancy outcome.Results The levels of serum Xenin-25 and CTRP12 in the GDM group were lower than those in the control group,while the levels of fasting plasma glucose(FPG),glycosylated hemoglobin(HbA_(1c)),fasting insulin(FINS)and homeostasis model assessment of insulin resistance(HOMA-IR)were higher than those in the control group(t/P=16.046/<0.001,22.114/<0.001,11.510/<0.001,13.666/<0.001,12.101/<0.001,14.413/<0.001).Serum Xenin-25 and CTRP12 levels were negatively correlated with FPG,HbA_(1c),FINS and HOMA-IR in GDM group(Xenin-25:r/P=-0.665/<0.001,-0.598/<0.001,-0.567/<0.001,-0.702/<0.001;CTRP12:r/P=-0.579/<0.001,-0.622/<0.001,-0.667/<0.001,-0.725/<0.001);Compared with the good prognosis subgroup,the poor prognosis subgroup had lower serum CTRP12 and Xenin-25 and higher HOMA-IR(t/P=6.783/<0.001,17.997/<0.001,15.146/<0.001).High serum CTRP12 and Xenin-25 were independent protective factors for adverse pregnancy outcomes in GDM patients[OR(95%CI)=0.646(0.499-0.837),0.619(0.465-0.824)],and high HOMA-IR was risk factor[OR(95%CI)=1.353(1.110-1.649)].The AUC of serum Xenin-25,CTRP12 and their combination for predicting adverse pregnancy outcomes in GDM patients were 0.828,0.815 and 0.870,respectively.The combination of xenin-25 and CTRP12 was superior to their individual prediction efficacy(Z/P=4.113/0.003,4.327/0.001).Conclusion GDM patients have decreased serum CTRP12 and Xenin-25 levels,which are involved in the disease process of GDM.The combination of CTRP12 and Xenin-25 has a high evaluation value for adverse pregnancy outcomes in GDM patients.
作者
张杰
王静
刘启航
祝静
吴斌
陈小芬
Zhang Jie;Wang Jing;Liu Qihang;Zhu Jing;Wu Bin;Chen Xiaofen(Department of Reproductive Medicine,Affiliated Hospital of North Sichuan Medical College,Sichuan Province,Nanchong 637000,China)
出处
《疑难病杂志》
CAS
2024年第8期940-944,共5页
Chinese Journal of Difficult and Complicated Cases
基金
四川省科技计划项目(20RKX0095)。
