中孕早期血清载脂蛋白CⅢ、脂联素及瘦素联合年龄对妊娠期糖尿病的预测研究  

Predictive Value of apo CⅢ,Adiponectin,Leptin and Age in Gestational Diabetes Mellitus at Early Stage of Second Trimester

作　　者：李跃萍[1] 闫庆峰[2] 吴小妹[1] 金松[1] 胡春霞[1] 符火[1] 李武莉[1] 

机构地区：[1]海南医学院附属医院,海南海口571199 [2]海南医学院病理生理教研室,海南海口571199

出　　处：《实用妇产科杂志》2016年第11期839-842,共4页Journal of Practical Obstetrics and Gynecology

基　　金：海南省自然科学基金资助(编号:20158323);海口市重点科技计划资助(编号:2014-063);海南省卫生厅资助(编号:琼卫2012PT-26)

摘　　要：目的：探索中孕早期孕妇年龄和血清脂联素（APN）、瘦素（1eptin）及载脂蛋白CⅢ（apoCⅢ）与妊娠期糖尿病（GDM）发病的相关性及其联合预测GDM的可行性。方法：采用前瞻性巢式病例对照研究，选取门诊正规产检的孕妇，孕16～18周产检时采集血清，用ELISA进行APN、Leptin及apoCⅢ测定；孕24周～28周进行常规OGTT筛查，确诊为GDM的孕妇纳入GDM组，余为对照组。用非配对t检验比较两组间的差异；用多变量Logistic回归分析模型判断多指标联合预测GDM的可行性。结果：纳入观察的孕妇405例，失访13例，完成随访的病例392例，失访率3．2％。392例孕24～28周OGTY筛查出GDM26例，GDM发病率6．6％。GDM组年龄高于对照组，差异有统计学意义（P〈0．05），而在孕周、孕前体质量及孕前体质量指数（BMI）方面比较差异无统计学意义（P〉0．05）。GDM组APN比对照组降低，Leptin比对照组升高，差异均有统计学意义（P〈0．05），而apoCⅢ在GDM组与对照组间差异无统计学意义（P〉0．05）。Logistic回归分析显示，APN为保护性因素，与GDM的发生呈负相关；而Leptin及年龄则为GDM发生的危险因素。将APN、Leptin和年龄依次引入回归方程后，回归方程的分类能力可达到86％，与上述因子的单独预测效果相比，联合预测的ROC曲线下面积明显增加，可达到0．805。结论：在中孕早期，APN、Leptin及年龄对GDM有一定的预测价值，APN、Leptin及年龄联合预测GDM有相对较高的敏感性和特异性，其预测价值高于单独子页测。Objective：To evaluate the correlation and predictive value of age and serum level of APN （adiponectin）, Leptin,apo C III （apolipoprotein C） for GDM at early stage of second trimester. Methods：The pregnant women＇s serum were collected at 16 -18 weeks of gestation and the levels of APN, Leptin and ApoC III were detected by ELISA. The regular OGTT was performed at 24 -28 weeks of gestation to all cases. The women who were diagnosed gestational diabetes mellitus belong to the GDM group,while the rest belong to the control group. The differences between two groups were compared by non-pairt test. The multivariate logistic regression analysis model was used to evaluate the possibility of prediction by combination multifactor for GDM. Results： There were 405 pregnant women in this research. 13 cases were lost to follow-up,the rate of lost to follow-up was 3.2%. Through the regular OGTT screening,26 cases were diagnosed GDM and the incidence of GDM is 6.6%. The age in GDM group was significant higher than control group（ P 〈0.05） ,while there were no significant differences in gestational weeks, weight and BMI before pregnancy between two groups （ P 〉 0.05）. Compared with control group,the lower level of APN and higher level of Leptin in GDM group has significant difference, （ P 〈0.05） ,while no significant difference was found in apo C III between two groups （P 〉 0.05）. The analysis of Logistic regression showed that APN is a protective factors,which is negatively Correlated with the occurrence of GDM,and Leptin and age are risk factors for GDM. After introducing these factors into regression equation in turn,the classification ability of the regression equation can reach 86%. Compared with these predictor factors individually,the predictive ability for GDM significantly improved by combined prediction,the area under the ROC curve can reach 0. 805. Conclusions.At early stage of second-trimester,the combination of APN, Leptin and age has higher prediction value for GDM than individu

关 键 词：妊娠期糖尿病 脂联素 瘦素 载脂蛋白CⅢ 年龄 

分 类 号：R714.256[医药卫生—妇产科学]