妊娠早期血清分泌型卷曲相关蛋白5水平对于妊娠糖尿病的早期诊断预测价值  

Prediction value of first trimester serum Sfrp-5 level for gestational diabetes mellitus

作　　者：张伟[1] 黄素花 王铁军[1] 赵绍杰[1] ZHANG Wei HUANG Suhua WANG Tiejun et al.(Department of Obstetrics and Gynecology, Wuxi Maternity and Child Care Service Centre, Wuxi 214002, China)

机构地区：[1]江苏省无锡市妇幼保健院妇产科,214002

出　　处：《浙江医学》2017年第20期1752-1755,共4页Zhejiang Medical Journal

摘　　要：目的探讨妊娠早期血清卷曲相关蛋白5(Sfrp-5)水平对于妊娠糖尿病(GDM)的早期诊断预测价值。方法纳入孕妇320例,根据孕24~28周行75g口服葡萄糖耐量试验结果,将纳入孕妇分为GDM组32例和非GDM组288例。两组孕妇分别在妊娠早期和中期时检测血清Sfrp-5水平,并进行胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能[β细胞功能指数(HOMA-β)、胰岛素曲线下面积(INSAUC)、血糖曲线下面积(PGAUC)、两者比值(INSAUC/PGAUC)和早期胰岛素分泌功能指数(△I30/△G30)]计算。通过ROC曲线分析血清Sfrp-5水平对于GDM的早期预警价值,并计算出最佳切点值(Cut-off值)。采用Pearson相关分析血清Sfrp-5水平与GDM、孕期BMI、HOMA-IR、胰岛β细胞功能指标的相关性,采用logistic回归分析GDM发生的独立危险因素。结果GDM组孕妇妊娠早期和中期妊娠血清Sfrp-5水平、HOMA-β、INSAUC/PGAUC和△I30/△G30均明显低于非GDM组,HOMA-IR明显高于非GDM组,差异均有统计学意义(均P<0.05)。妊娠早期和中期血清Sfrp-5水平与GDM的发生均呈负相关(r=-0.636和-0.684,均P<0.01)。妊娠早期血清Sfrp-5水平的诊断价值最高,AUC为0.788,95%CI为0.712~0.855,Cut-off值为10.5ng/ml,灵敏度为82%,特异度为78%。妊娠早期血清Sfrp-5水平<10.5ng/ml和妊娠中期血清Sfrp-5水平<6.8ng/ml为GDM发生的独立危险因素(OR=1.55和1.22,均P<0.05)。结论妊娠早期时血清Sfrp-5水平下降是GDM的重要预警因子。Objective To assess the prediction value of first trimester serum secreted frizzle-related protein-5（ Sfrp-5） levels for gestational diabetes mellitus （GDM）. Methods Three hundred and twenty pregnant women were enrolled in this study and divided to two groups based on glucose tolerance screening： GDM group（n=28） and non-GDM group（n=288）. Serum Sfrp-5 levels were measured on first and second trimester of pregnancy. All enrolled pregnant women were receiving insulin resistance（HOMA-IR） and beta cell function evaluation （HOMA- p , INSauc , PGauc , INSauc /PGauc and A I30 /AG 30 ）. ROC analysis was used for evaluate the early prediction value of Sfrp-5 for GDM. Pearson correlation was used to analyze the association between GDM and Sfrp-5. Logistic regression was used to determinate the risk factors for GDM. Results The serum Sfrp-5 level, HOMA-p, INSauc/PGauc and AI33 /AG 33 in GDM group were lower than those in non-GDM group on both first and second trimester of pregnancy, while HOMA-IR were higher than those in non-GDM group（all P〈〇 .〇 5）. Correlation analysis showed that contents of Sfrp-5 were negatively associated with GDM on both first and second trimester of pregnancy. ROC analysis suggested that AUC of Sfrp-5 on first trimester of pregnancy was 0.788, the sensitivity and specificity were 82% and 78% when 10.5ng/ml was taken as Cut-off value. Logistic analysis indicated that serum Sfrp-5 on first （〈10.5ng/ml） and second trimester （〈 6.8ng/ml） of pregnancy were independent risk factors for GDM （OR=1.55 and 1.22, both P〈0.05）. Conclusion The reduction of serum Sfrp-5 level on first trimester of pregnancy may be an important warning marker for GDM.

关 键 词：分泌型卷曲相关蛋白5 妊娠糖尿病 早期诊断 

分 类 号：R714.256[医药卫生—妇产科学]