血清不对称二甲基精氨酸、妊娠相关蛋白-A、胰岛素样生长因子-1水平与妊娠糖尿病患者妊娠结局的相关性  

Correlation of serum asymmetric dimethylarginine,pregnancy-associated protein-A and insulin-like growth factor-1 with pregnancy outcome in patients with gestational diabetes mellitus

作　　者：任汉强[1] 陈伟[1] 沈小波[1] 王芳[1] 王娟[1] REN Hanqiang;CHEN Wei;SHEN Xiaobo;WANG Fang;WANG Juan(Department of Endocrinology,Affiliated Hospital of Jianghan University,Wuhan,Hubei 430015,China)

机构地区：[1]江汉大学附属医院内分泌科,湖北武汉430015

出　　处：《国际检验医学杂志》2022年第7期796-800,805,共6页International Journal of Laboratory Medicine

基　　金：湖北省卫生与计划生育委员会临床医学科研基金项目(WX18D05)。

摘　　要：目的探讨血清不对称二甲基精氨酸(ADMA)、妊娠相关蛋白-A(PAPP-A)、胰岛素样生长因子-1(IGF-1)水平与妊娠糖尿病(GDM)患者妊娠结局的相关性。方法选取该院2019年1月至2021年1月收治的100例GDM患者作为GDM组,选取同期60例糖耐量异常(AGT)孕妇作为ATG组,另选取同期60例产检正常的健康孕妇作为对照组。比较3组血清ADMA、PAPP-A、IGF-1水平和不良妊娠结局发生率。采用Pearson相关分析GDM患者血清ADMA、PAPP-A、IGF-1水平间的相关性。采用多因素Logistics回归分析GDM患者不良妊娠结局的影响因素。ROC曲线分析血清ADMA、PAPP-A、IGF-1水平对GDM患者不良妊娠结局的预测价值。结果GDM组血清ADMA、IGF-1水平高于ATG组、对照组(P<0.05),PAPP-A水平低于ATG组、对照组(P<0.05);ATG组血清ADMA、IGF-1水平高于对照组(P<0.05),PAPP-A水平低于对照组(P<0.05)。GDM患者血清PAPP-A水平与ADMA、IGF-1水平呈负相关(r=-0.536、-0.601,P<0.001),ADMA水平与IGF-1水平呈正相关(r=0.587,P<0.001)。GDM组不良妊娠结局发生率高于ATG组、对照组(P<0.05),ATG组不良妊娠结局发生率高于对照组(P<0.05)。糖化血红蛋白(OR=1.703,95%CI:1.247~2.235)、胰岛素抵抗指数(OR=1.384,95%CI:1.158~1.894)、ADMA(OR=1.583,95%CI:1.224~2.163)、IGF-1(OR=1.051,95%CI:1.018~1.085)为GDM患者不良妊娠结局独立危险因素(P<0.05),PAPP-A(OR=0.692,95%CI:0.422~1.137)为保护因素(P<0.05)。ADMA、PAPP-A、IGF-1和3项联合预测GDM患者不良妊娠结局的曲线下面积(AUC)分别为0.743、0.732、0.731、0.852,3项联合预测GDM患者不良妊娠结局的AUC大于ADMA、PAPP-A、IGF-1单独预测(P<0.05)。结论GDM患者血清ADMA、IGF-1水平升高,PAPP-A水平降低。ADMA、IGF-1为不良妊娠结局的独立危险因素,PAPP-A为保护因素。联合检测这3项指标有助于准确预测不良妊娠结局,指导临床干预,改善妊娠结局。Objective To investigate the correlation between serum asymmetric dimethylarginine(ADMA),pregnancy-associated protein-A(PAPP-A),insulin-like growth factor-1(IGF-1)and pregnancy outcome in patients with gestational diabetes mellitus(GDM).Methods A total of 100 GDM patients admitted to the hospital from January 2019 to January 2021 were enrolled as the GDM group,60 pregnant women with impaired glucose tolerance(AGT)in the same period were enrolled as the ATG group,and 60 healthy pregnant women with normal obstetrics during the same period were enrolled as the controls group.The serum ADMA,PAPP-A,IGF-1 levels and the incidence of adverse pregnancy outcomes were compared among the three groups.Pearson correlation was used to analyze the correlation between serum ADMA,PAPP-A and IGF-1 levels in patients with GDM.Multivariate Logistic regression was used to analyze the influencing factors of adverse pregnancy outcomes in GDM patients.The predictive value of serum ADMA,PAPP-A and IGF-1 levels on adverse pregnancy outcomes in GDM patients was analyzed by ROC curve.Results Serum ADMA and IGF-1 levels in the GDM group were higher than those in the ATG and control groups,and PAPP-A levels were lower than those in the ATG and control groups(P<0.05);serum ADMA and IGF-1 levels in the ATG group were higher than those in the control group,and PAPP-A levels were lower than those in the control group(P<0.05).The incidence of adverse pregnancy outcomes was higher in the GDM group than that in the ATG and control groups(P<0.05),and the incidence of adverse pregnancy outcomes was significantly higher in the ATG group than in the control group(P<0.05).Serum PAPP-A levels in GDM patients were negatively correlated with ADMA and IGF-1 levels(r=-0.536、-0.601,P<0.001),and ADMA levels were positively correlated with IGF-1 levels(r=0.587,P<0.001).Glycosylated hemoglobin(HbA1c,OR=1.703,95%CI:1.247-2.235),insulin resistance index(HOMA-IR,OR=1.384,95%CI:1.158-1.894),ADMA(OR=1.583,95%CI:1.224-2.163),IGF-1(OR=1.051,95%CI:1.018-1.085)were inde

关 键 词：妊娠糖尿病 不对称二甲基精氨酸 妊娠相关蛋白-A 胰岛素样生长因子-1 妊娠结局 

分 类 号：R446.11[医药卫生—诊断学]