妊娠早期血清补体C1q/肿瘤坏死因子相关蛋白3对妊娠期糖尿病的影响及预测价值:一项前瞻性研究  

Association and Predictive Value of Maternal Serum C1q/Tumor Necrosis Factor-related Protein-3 Ratio with Gestational Diabetes Mellitus in Early Pregnancy:a Prospective Study

作　　者：张丽倩 郭艳巍[3] 许倩[4] 杨珽 毛淑芳[2] ZHANG Liqian;GUO Yanwei;XU Qian;YANG Ting;MAO Shufang(Department of Gynaecology,Tangshan Maternal and Child Health Hospital,Tangshan 063000,China;Department of Preventive Medicine,Chengde Medical University,Chengde 067000,China;Department of Obstetrics,Affiliated Hospital of Chengde Medical University,Chengde 067000,China;Institute of Basic Medicine,Chengde Medical University,Chengde 067000,China)

机构地区：[1]河北省唐山市妇幼保健院妇科,063000 [2]承德医学院预防医学教研室,河北省承德市067000 [3]承德医学院附属医院产科,河北省承德市067000 [4]承德医学院基础医学研究所,河北省承德市067000

出　　处：《中国全科医学》2022年第18期2249-2254,共6页Chinese General Practice

基　　金：河北省科技计划项目(162777102D);河北省医学科学研究重点课题计划(20170874);2019年政府资助临床医学优秀人才培养项目补助计划。

摘　　要：背景妊娠期糖尿病(GDM)以胰岛素抵抗为特征,补体C1q/肿瘤坏死因子相关蛋白3(CTRP3)与胰岛素抵抗关系密切,可能参与了GDM的发生、发展过程,但妊娠早期血清CTRP3与GDM的关系及其预测价值如何,相关研究报道较少。目的探讨妊娠早期血清CTRP3对GDM的影响及预测价值,为GDM的防治提供新思路。方法前瞻性连续选取2018年6月至2019年3月在承德医学院附属医院产科门诊正规产检的妊娠早期女性为研究对象。收集孕妇的一般资料,妊娠6~14周时检测空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA_(1c))、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及血清CTRP3。妊娠24~28周时采用75 g口服葡萄糖耐量试验进行GDM筛查,分为GDM组和糖耐量正常(NGT)组。结果共纳入妊娠早期妇女393例,最终纳入分析368例,其中81例妊娠24~28周时诊断为GDM,GDM的发病率为22.0%。GDM组的年龄大于NGT组,妊娠前体质指数(BMI)、FPG、FINS、HbA_(1c)及TG均高于NGT组(P<0.05)。GDM组血清CTRP3低于NGT组〔0.5280(0.4613,0.6340)μg/L与0.6048(0.5108,0.6660)μg/L,P=0.001〕。多因素Logistic回归分析显示血清CTRP3是GDM发生的独立影响因素〔aOR=0.101,95%CI(0.010,0.997),P≤0.05〕。血清CTRP3预测GDM的截断值是0.5242μg/L,灵敏度为49.38%,特异度为72.13%,受试者工作特征曲线下面积(AUC)为0.622〔95%CI(0.571,0.672)〕;联合预测模型(CTRP3联合年龄、妊娠前BMI、FPG及HbA_(1c))预测GDM的截断值是0.3150,灵敏度为69.14%,特异度为89.20%,AUC为0.841〔95%CI(0.799,0.877)〕。联合预测模型预测GDM的AUC大于血清CTRP3的AUC(Z=5.634,P<0.001)。结论妊娠早期母体血清CTRP3升高可降低GDM的发生风险,是GDM的独立预测因子,与母体特征及代谢指标联合对GDM具有较好的预测价值。Background Gestational diabetes mellitus(GDM)is characterized by increased insulin resistance.As serum complement C1q/tumor necrosis factor-related protein 3(CTRP3)ratio is closely related to insulin resistance,which may be involved in the development of GDM.However,the association and predictive value of serum CTRP3 ratio with GDM in early pregnancy have been rarely reported.Objective To explore the association and predictive value of serum CTRP3 ratio with GDM in early pregnancy,providing new ideas for the prevention and treatment of GDM.Methods Women in early pregnancy who underwent regular obstetric examinations in Obstetric Clinic,Affiliated Hospital of Chengde Medical University,were prospectively and consecutively enrolled from June 2018 to March 2019.Demographics,fasting plasma glucose(FPG),fasting insulin(FINS),glycosylated hemoglobin(HbA_(1c)),triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)and serum CTRP3 ratio measured at 6-14 weeks of gestation were collected.The 75 g oral glucose tolerance test(OGTT)was performed to screen GDM at 24-28 weeks of gestation.The patients were divided into GDM group and normal glucose tolerance(NGT)group.Results Finally,368 of the 393 cases were enrolled for analysis,including 81(22.0%)who were detected with GDM by the 75 g OGTT.Compared with those with normal glucose tolerance(NGT)diagnosed by the 75 g OGTT,GDM cases had much greater average age,pre-pregnancy BMI,FPG,FINS,HbA_(1c),and TG(P<0.05).Serum CTRP3 ratio in GDM group was lower than that in NGT group〔0.5280(0.4613,0.6340)μg/L vs 0.6048(0.5108,0.6660)μg/L,P=0.001〕.Multivariate Logistic regression analysis showed that serum CTRP3 ratio was an independently associated with GDM〔aOR=0.101,95%CI(0.010,0.997),P≤0.05〕.The AUC of serum CTRP3 ratio in predicting GDM was 0.622〔95%CI(0.571,0.672)〕with 49.38%sensitivity,and 72.13%specificity when≤0.5242μg/L was chosen as the optimal cutoff value.The AUC of a combined prediction mo

关 键 词：糖尿病 妊娠 补体C1q/肿瘤坏死因子相关蛋白3 体质指数 葡糖耐量试验 

分 类 号：R714.256[医药卫生—妇产科学]