摘要
目的 探究外周血白介素-10(IL-10)、白介素-33(IL-33)及其受体可溶性肿瘤抑制素2(sST2)水平与妊娠期糖尿病(GDM)患者不良妊娠结局的关系。方法 选取2022年7月至2023年7月在我院建档产检的GDM患者80例纳入研究组,同期在我院进行产检的健康孕产妇80例纳入对照组,比较两组产妇孕37周时的外周血IL-10、IL-33及其受体sST2水平。对研究组患者进行追踪随访,并根据不同妊娠结局将研究组分为良好结局组(获得良好妊娠结局,n=55)和不良结局组(发生不良妊娠结局,n=25),探究影响GDM患者妊娠结局的因素,以及外周血IL-10、IL-33及其受体sST2水平对不良妊娠结局的预测价值。结果 研究组和对照组患者的年龄、孕次、产次、总胆固醇、受教育年限、孕前体质量指数(BMI)比较均无显著性差异(P>0.05),但研究组分娩前BMI、胰岛素抵抗指数均显著高于对照组(P<0.05)。研究组患者的IL-10水平显著低于对照组,IL-33及sST2水平显著高于对照组(P均<0.05)。对照组发生1例产后出血,2例巨大儿,不良妊娠结局总发生率为3.75%;研究组发生3例产后出血,5例巨大儿,8例新生儿窒息,6例足月低体重儿,3例胎儿发育异常,不良妊娠结局总发生率为31.25%,显著高于对照组(P<0.05)。研究组中,不良结局组患者的IL-10水平显著低于良好结局组,IL-33及sST2水平显著高于良好结局组(P均<0.05)。经单因素及多因素分析,IL-10、IL-33、sST2、胰岛素抵抗指数均能影响GDM患者的妊娠结局(P<0.05)。经受试者工作特征(ROC)曲线分析,IL-10、IL-33、sST2对GDM患者不良妊娠结局具有一定预测价值,曲线下面积(AUC)分别为0.969、0.945、0.960(P<0.05)。结论 外周血IL-10、IL-33及其受体sST2水平在预测GDM患者的新生儿窒息、产后出血、巨大儿、足月低体重儿、胎儿发育异常等不良妊娠结局方面具有潜在的临床应用价值,有助于早期识别上述高风险患者,以采取积极有效的干预措施改善妊娠结局。
Objective:To investigate the relationship between levels of interleukin(IL)-10,IL-33,and their soluble receptor soluble suppression of tumorigenicity-2(sST2)in peripheral blood and adverse pregnancy outcomes in patients with gestational diabetes mellitus(GDM).Methods:From July 2022 to July 2023,80 GDM patients who underwent prenatal examination were prospectively selected and enrolled into the study group at Kunming Maternal and Child Health Hospital,along with 80 healthy pregnant women who underwent prenatal examination over the same period and served as the control group.The levels of IL-10,IL-33,and sST2 in peripheral blood at 37 weeks of pregnancy were compared between the two groups.The study group was further divided based on pregnancy outcomes into a favorable outcome group(n=55)and an adverse outcome group(n=25).Factors affecting the pregnancy outcomes in GDM patients were investigated,and the predictive value of IL-10,IL-33,and sST2 levels for adverse outcomes was assessed.Results:There were no significant differences in the age,the number of pregnancy/births,the duration of education,total cholesterol level,and preconception body mass index(BMI)between the two groups(P>0.05).However,BMI before delivery and insulin resistance index were higher in the study group(P<0.05).The level of IL-10 was significantly lower,and the levels of IL-33 and sST2 were significantly higher in the study group compared to the control group(all P<0.05).The control group had a total adverse outcome incidence of 3.75%with one case of postpartum haemorrhage and two cases of macrosomia,whereas the study group had an incidence of 31.25%with three cases of postpartum haemorrhage,five cases of macrosomia,eight cases of neonatal asphyxia,six cases of full-term low birth weight infants and three cases of abnormal fetal development,significantly higher than the control group(P<0.05).In the study group,IL-10 level was significantly lower and IL-33 and sST2 levels were significantly higher in the adverse outcome group than those of the favorable outcome group(all P<0.05).Univariate and multivariate analyses revealed that IL-10,IL-33,sST2,and insulin resistance index could affect pregnancy outcomes in GDM patients(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that IL-10,IL-33 and sST2 have predictive value for adverse pregnancy outcomes in GDM patients,with area under curve(AUC)of 0.969,0.945,and 0.960,respectively(P<0.05).Conclusions:Peripheral blood levels of IL-10,IL-33,and sST2 have potential clinical value in predicting adverse pregnancy outcomes such as neonatal asphyxia,postpartum haemorrhage,macrosomia,full-term low birth weight,and abnormal fetal development in GDM patients,which helps to identify high-risk patients early and take proactive and effective intervention measures to improve pregnancy outcomes.
作者
范薇
沈翠花
康玮
李馨
孙宇
FAN Wei;SHEN Cui-hua;KANG Wei;LI Xin;SUN Yu(Department of Obstetrics,Kunming Maternal and Child Health Hospital,Kunming 650031)
出处
《生殖医学杂志》
CAS
2024年第11期1463-1469,共7页
Journal of Reproductive Medicine
基金
昆明市卫生健康委员会卫生科研课题项目(2022-05-02-012)。
关键词
白介素-10
白介素-33
可溶性肿瘤抑制素2
妊娠期糖尿病
妊娠结局
Interleukin-10
Interleukin-33
Soluble suppression of tumorigenicity-2
Gestational diabetes mellitus
Pregnancy outcomes
