血清SHBG、nesfatin-1及sFRP4在妊娠期糖尿病早期诊断中的价值  

Expression and clinical significance of serum SHBG, nesfatin-1 and sFRP4 in patients with gestational diabetes mellitus

作　　者：蒋晓辉[1] 宋欢欢[1] 王冉 JIANG Xiao-hui;SONG Huan-huan;WANG Ran(Department of Obstetrics,Zhengzhou First People's Hospital,Zhengzhou,Henan 450000,China)

机构地区：[1]郑州市第一人民医院产科,河南郑州450000

出　　处：《热带医学杂志》2020年第6期815-819,共5页Journal of Tropical Medicine

基　　金：郑州市科技实验基金(HUGP-201605125458)。

摘　　要：目的探究血清性激素结合球蛋白(SHBG)、摄食抑制因子1(Nesfatin-1)、分泌型卷曲相关蛋白4(sFRP4)在妊娠期糖尿病(GDM)早期诊断中的应用价值。方法选取郑州市第一人民医院产科2017年7月-2019年7月收治的72例GDM患者作为研究组,以同期体检的健康孕妇60名作为对照组,统计记录患者临床资料,并测定血糖、血脂、血压、胰岛素等指标,计算孕前体质量指数(BMI)和胰岛素抵抗指数(HOMA-IR),采用酶联免疫吸附法(ELISA)检测血清SHBG、Nesfatin-1及sFRP4水平,分析血清SHBG、Nesfatin-1及sFRP4与临床生化指标的相关性,受试者工作曲线(ROC)分析SHBG、Nesfatin-1及sFRP4诊断GDM的临床价值。结果两组研究对象年龄、孕周、孕次、孕前BMI及低密度脂蛋白胆固醇(LDL-C)比较差异无统计学意义(P>0.05);两组研究对象收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、餐后2 h血糖(2 hBG)、糖化血红蛋白(HbAlc)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、空腹胰岛素(FINS)、HOMA-IR、SHBG、Nesfatin-1及sFRP4比较差异均有统计学意义(P<0.05)。相关性分析结果显示,血清SHBG、Nesfatin-1及sFRP4与FBG、2 h BG、HbAlc、FINS、HOMA-IR存在正相关性(P<0.05),与HDL-C存在明显负相关性(P<0.05)。ROC曲线显示,血清SHBG、Nesfatin-1及sFRP4诊断GDM的曲线下面积(AUC)分别为0.848(95%CI:0.786~0.910)、0.761(95%CI:0.682~0.840)及0.856(95%CI:0.785~0.927),3指标联合检测的AUC为0.916(95%CI:0.872~0.959)。发生妊娠不良结局及未发生妊娠不良结局GDM孕妇血清SHBG、Nesfatin-1及sFRP4水平差异有统计学意义(P<0.05),血清SHBG、Nesfatin-1及sFRP4水平与GDM不良妊娠结局存在明显相关性(P<0.05)。结论 GDM患者血清SHBG、Nesfatin-1及sFRP4水平明显升高,并与患者血糖、胰岛素抵抗及HDL-C等存在明显关系,3指标检测对于GDM的诊断具有较高价值。Objective To investigate the expression and clinical significance of serum sex hormone-binding globulin(SHBG),food inhibitory factor 1(Nesfatin-1) and secreted frizzled-related protein 4(sFRP4) in patients with gestational diabetes mellitus(GDM).Methods Seventy-two patients with GDM admitted to our hospital from July 2017 to July 2019 were enrolled as the study group.60 healthy pregnant women who came to our hospital for the same period were selected as the control group.The clinical data were recorded and blood glucose and blood lipids were measured.Blood pressure,insulin and other indicators,pre-pregnancy body mass index(BMI) and insulin resistance index(HOMA-IR) were calculated.Serum SHBG,Nesfatin-1 and sFRP4 levels were measured by enzyme-linked immunosorbent assay(ELISA).The correlations between serum SHBG,Nesfatin-1 and sFRP4 and clinical biochemical indicators were analyzed.The diagnostic values of SHBG,Nesfati-1 and sFRP4 of GDM were evaluated by receiver operating curve(ROC) analysis.Results There were no significant differences in age,gestational age,pregnancy,pre-pregnancy BMI and low-density lipoprotein cholesterol(LDL-C) between the two groups(P>0.05).The differences in systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),2 h postprandial blood glucose(2 h BG),glycated hemoglobin(HbAlc),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),fasting insulin(FINS),and HOMA-IR between the two groups were statistically significant(P<0.05).The differences in levels of serum SHBG,Nesfatin-1 and sFRP4 between the two groups were statistically significant(P<0.05).Correlation analysis showed that serum SHBG,Nesfatin-1 and sFRP4 were positively correlated with FBG,2 h BG,HbAlc,FINS,HOMA-IR(P<0.05),and negatively correlated with HDL-C(P<0.05).The ROC curve showed that the areas under the curves(AUC)of serum SHBG,Nesfatin-1 and sFRP4 diagnosis of GDM were 0.848(95%CI:0.786-0.910),0.761(95% CI:0.682-0.840) and 0.856(95%CI:0.785-0.927),respectively.The A

关 键 词：妊娠期糖尿病 性激素结合球蛋白 摄食抑制因子1 分泌型卷曲相关蛋白4 

分 类 号：R587.1[医药卫生—内分泌]