妊娠早期血清胎盘亮氨酸氨基肽酶和摄食抑制因子水平对妊娠期糖尿病的预测价值  

Predictive value of serum placenta-leucine aminopeptidase and nesfatin-1 levels in early pregnancy for GDM

作　　者：严红艳[1] 夏雪梅[1] 叶夏斌 YAN Hong-yan;XIA Xue-mei;YE Xia-bin(Department of Obstetrics and Gynecology,Lishui City People's Hospital,Lishui,Zhejiang 323020,China)

机构地区：[1]丽水市人民医院妇产科

出　　处：《中国妇幼保健》2023年第3期389-393,共5页Maternal and Child Health Care of China

基　　金：浙江省医药卫生科技计划项目临床研究应用项目(2022ZH099)。

摘　　要：目的 分析妊娠早期血清胎盘亮氨酸氨基肽酶(P-LAP)、摄食抑制因子(NSF-1)水平对妊娠期糖尿病(GDM)的预测价值。方法 选取2021年2月—2022年2月丽水市人民医院收治的110例GDM患者为研究对象(GDM组),另选取同期于该院接受产前检查的110例健康孕妇作为对照(Normal组),比较两组临床资料、妊娠早期血清指标[空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、肿瘤坏死因子-α(TNF-α)、P-LAP及NSF-1]水平,通过logistic多因素分析明确妊娠早期相关指标与GDM的相关性,通过受试者工作特征(ROC)曲线分析明确妊娠早期血清P-LAP、NSF-1指标对GDM的预测价值。结果 GDM组体质指数(BMI)(26.01±2.81)kg/m^(2)、FPG(4.28±0.43)mmol/L、FINS(13.01±2.22)μIU/ml、HbA1c(6.71±1.12)%、TG(1.49±0.42)mmol/L、TC(4.51±0.67)mmol/L、HDL(1.85±0.36)mmol/L高于Normal组BMI(24.84±2.76)kg/m^(2)、FPG(3.59±0.36)mmol/L、FINS(7.75±2.49)μIU/ml、HbA1c(5.03±0.55)%、TG(1.33±0.36)mmol/L、TC(4.03±0.51)mmol/L、HDL(1.50±0.21)mmol/L,而NSF-1(1.69±0.33)μg/L、P-LAP(539.48±148.76)pg/ml低于Normal组NSF-1(2.35±0.35)μg/L、P-LAP(894.60±259.66)pg/ml(P<0.05)。logistic多因素分析结果显示,妊娠早期血清FPG、NSF-1、P-LAP指标是预测GDM的危险因素(P<0.05)。ROC曲线分析显示,FPG+NSF-1+P-LAP预测GDM的曲线下面积(AUC)上升至0.980,高于各单项血清指标与NSF-1+P-LAP预测结果(P<0.05),以0.436为联合预测cut-off,其预测灵敏度、特异度分别为95.45%、92.73%。结论 妊娠早期血清P-LAP、NSF-1指标单独或联合预测GDM的临床价值较高,但在此基础上联合血清FPG或可进一步提高预测效能。Objective To analyze the predictive value of serum placenta-leucine aminopeptidase(P-LAP) and feeding inhibitory factor(NSF-1) levels in early pregnancy in gestational diabetes mellitus(GDM).Methods 110 GDM patients admitted to our hospital from February 2021 to February 2022 were selected as the research objects(GDM group),and 110 healthy pregnant women who received prenatal examinations in Lishui City People’s Hospital during the same period(Normal group) were also selected.Comparison of clinical data, early pregnancy serum indexes [fasting plasma glucose(FPG),fasting insulin(FINS),glycosylated hemoglobin(HbA1c),triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL)],low-density lipoprotein cholesterol(LDL),tumor necrosis factor-α(TNF-α),P-LAP,NSF-1] between the two groups.Logistic multivariate analysis was used to determine the correlation between related indicators in early pregnancy and GDM,and receiver operating characteristic(ROC) curve analysis was used to determine the predictive value of serum P-LAP and NSF-1 indicators in early pregnancy for GDM.Results The body mass index(BMI)(26.01±2.81)kg/m~2,FPG(4.28±0.43)mmol/L,FINS(13.01±2.22)μIU/ml, HbA1c(6.71±1.12)%,TG(1.49±0.42)mmol/L,TC(4.51±0.67)mmol/L and HDL(1.85±0.36)mmol/L in GDM group were higher than BMI(24.84±2.76)kg/m~2,FPG(3.59±0.36)mmol/L,FINS(7.75±2.49)μIU/ml, HbA1c(5.03±0.55)%,TG(1.33±0.36)mmol/L,TC(4.03±0.51)mmol/L and HDL(1.50±0.21)mmol/L in Normal group(P<0.05),but NSF-1(1.69±0.33)μg/L and P-LAP(539.48±148.76)pg/ml were lower than NSF-1(2.35±0.35)μg/L and P-LAP(894.60±259.66)pg/ml in Normal group(P<0.05).Logistic multivariate analysis showed that serum FPG,NSF-1 and P-LAP indexes in early pregnancy were risk factors for predicting GDM(P<0.05).The ROC curve analysis showed that the area under the curve(AUC) of FPG+NSF-1+P-LAP for predicting GDM increased to 0.980,which was higher than the prediction results of each single serum index and NSF-1+P-LAP(P<0.05).Taking 0.436 as the joint prediction

关 键 词：妊娠期糖尿病 妊娠早期 胎盘亮氨酸氨基肽酶 摄食抑制因子 

分 类 号：R714.256[医药卫生—妇产科学]