孕早期血清PAPP-A水平对妊娠期糖尿病预测价值的探讨  

PAPP-A in predicting gestational diabetes mellitus at early pregnancy

作　　者：毕雪玲[1] 张芬[1] 陈玉花[1] 薛燕[1] BI Xue-ling;ZHANG Fen;CHEN Yu-hua(Department of Obstetrics and Gynecology, Yan'an People's Hospital, Yan'an Shaanxi 716000, China)

机构地区：[1]延安市人民医院妇产科,陕西延安716000

出　　处：《临床和实验医学杂志》2019年第1期62-66,共5页Journal of Clinical and Experimental Medicine

摘　　要：目的探讨孕早期血清中的妊娠相关血浆蛋白A(PAPP-A)水平对妊娠期糖尿病(GDM)的预测价值。方法前瞻性选取2015年3月至2017年2月在延安市人民医院进行常规产前检查并分娩的133例孕妇为研究对象,根据口服葡萄糖耐量试验(OGTT)检测结果将患者分为GDM组(OGTT阳性,63例)和对照组(OGTT阴性,70例),检查并比较两组孕妇的年龄、孕前BMI、孕期空腹血糖、分娩孕周、糖尿病家族史、高血压家族史、产次、分娩方式、新生儿性别、孕早期(9～13^(+6)周) PAPP-A水平等资料。采用多因素Logistic回归分析独立危险因素,并绘制PAPP-A、临床资料以及联合指标预测GDM发生的受试者工作曲线(ROC),根据曲线下面积比较PAPP-A、临床资料以及联合指标预测GDM发生的临床价值。结果对照组孕早期PAPP-A中位数倍数(Mo M)水平和分娩孕周高于GDM组[(0. 92±0. 04)vs.(0. 88±0. 03);(39. 45±1. 21)周vs.(38. 62±1. 01)周,P <0. 05],GDM组年龄、孕前BMI、空腹血糖水平、经产妇和剖宫产比率高于对照组[(31. 54±3. 67) vs.(29. 28±3. 94);(21. 06±1. 52) vs.(20. 18±1. 32);(6. 99±1. 20) vs.(4. 86±0. 81);(28/63) vs.(16/70);(28/63) vs.(17/70),P <0. 05]。多因素Logistic回归分析显示年龄[OR=1. 781,95%CI(1. 037～3. 059),P=0. 041]、孕前BMI[OR=2. 537,95%CI(1. 342～4. 797),P=0. 025]、产次[OR=1. 251,95%CI(1. 078～1. 452),P=0. 041]和PAPP-A MoM[OR=0. 699,95%CI(0. 505～0. 968),P=0. 047]。PAPP-A MoM预测GDM的ROC曲线下面积(0. 776)高于孕前BMI(0. 671),但小于联合检测的ROC曲线下面积(0. 821)。结论孕早期低PAPP-A是GDM发生的独立影响因素,并对GDM发生有一定的预测价值。Objective To explore the clinical value of serum pregnancy-associated plasma protein-A(PAPP-A)level in predicting gestational diabetes mellitus at early pregnancy.Methods 133 pregnant women in our hospital between March 2015 and February 2017 were enrolled and randomized into the(gestational diabetes mellitus)GDM group(n=63)and the normal group(n=70)according to their oral glucose tolerance test results.Age,pre-pregnancy body mass index(BMI),fasting glucose,the delivery gestational week(9~13+6),family history of diabetes and hypertension,the number of pregnancies,the delivery type,neonatal sex and serum PAPP-A during early pregnancy were compared between the two groups.Logistic regression model was established and the predictive efficacy of PAPP-A was evaluated by ROC curve.Results PAPP-A level at 9~13+6 weeks gestation and delivery week of the control was much higher than that of GDM group[(0.92±0.06)weeks vs.(0.88±0.05)weeks;(39.45±1.21)weeks vs.(38.62±1.01)weeks,P<0.05].GDM group was of higher age,pre-pregnancy BMI,fasting glucose,multipara rate and cesarean rate(P<0.05).Logistic regression showed age(OR=1.781,95%CI=1.037~3.059,P=0.041),pre-pregnancy BMI(OR=2.537,95%CI=1.342~4.797,P=0.025),the number of pregnancies(OR=1.251,95%CI=1.078~1.452,P=0.041)and PAPP-A(OR=0.699,95%CI=0.505~0.968,P=0.047)were relevant factors.The AUC under ROC curve for PAPP-A was 0.776,higher than that for BMI(0.671),but lower than that for joint prediction(0.821)(P<0.05).Conclusion Early pregnancy PAPP-A is an independent protection factor regarding GDM and with due predictive efficacy.

关 键 词：妊娠期糖尿病 PAPP-A 孕早期 预测 危险因素 

分 类 号：R714.256[医药卫生—妇产科学]