PAI-1基因多态性与孕早期糖化血红蛋白交互作用对妊娠期糖尿病发病的影响  

Effect of Interaction between PAI-1 Gene Polymorphism and Glycated Hemoglobin in First Trimester on the Incidence of Gestational Diabetes Mellitus

作　　者：李晓倩 李国芸[1] 孙志刚 马双玲 LI Xiaoqian;LI Guoyun;SUN Zhigang(Department of Obstetrics,Xinxiang Central Hospital,Xinxiang Henan 453000,China)

机构地区：[1]新乡市中心医院产科,河南新乡453000

出　　处：《实用妇产科杂志》2023年第9期700-705,共6页Journal of Practical Obstetrics and Gynecology

基　　金：河南省医学科技计划项目(编号:LHGJ20191322)。

摘　　要：目的:分析纤溶酶原激活物抑制物-1(PAI-1)基因多态性与孕早期糖化血红蛋白(HbA1c)水平交互作用,以期找出其对妊娠期糖尿病发病的影响。方法:选择2021年10月至2022年6月在新乡市中心医院早孕检查异常且孕期诊断为妊娠期糖尿病的30例孕妇作为妊娠期糖尿病组,另选取同时期早孕检查正常且孕期未被诊断为妊娠期糖尿病的45例孕妇作为对照组。Logistic回归模型分析影响妊娠期糖尿病发病的危险因素;受试者工作特征曲线(ROC)和校准曲线对模型进行评价。结果:妊娠期糖尿病组孕妇孕前体质量指数(BMI)、糖尿病家族史、空腹血糖、同型半胱氨酸(Hcy)、总胆红素水平(T-BIL)、低密度脂蛋白胆固醇(LDL-C)、空腹胰岛素(FINS)、HbA1c、PAI-1活性与对照组相比,差异有统计学意义(P<0.05)。两组孕妇PAI-1基因等位基因的分布比较,差异有统计学意义(P<0.05)。Logistic回归分析,空腹血糖高(OR 2.583)、FINS高(OR 1.984)、HbA1c高(OR 4.258)和PAI-1基因型(4G/4G)(OR 5.987)是妊娠期糖尿病发病的独立危险因素(P<0.05),T-BIL高(OR 0.429)为保护性因素(P<0.05)。ROC曲线和校准曲线显示该模型区分度和校准度良好;PAI-1基因型(4G/5G)和HbA1c≥8.0%、PAI-1基因型(4G/4G)和6.0%≤HbA1c<8.0%、PAI-1基因型(4G/4G)和HbA1c≥8.0%均存在正向交互作用(γ>1)。结论:携带PAI-1基因多态性与孕早期HbA1c水平具有协同交互作用,能够促进妊娠期糖尿病发病。在临床工作中应重视孕妇PAI-1基因型以及HbA1c水平升高的现象,有助于预测妊娠期糖尿病的发生。Objective:To analyze the interaction between plasminogen activator inhibitor(PAI-1)gene polymorphism and early pregnancy glycosylated hemoglobin(HbA1c)level,in order to find out its impact on the pathogenesis of gestational diabetes mellitus(GDM).Methods:Thirty pregnant women with abnormal early pregnancy examination and diagnosis of GDM during pregnancy at Xinxiang Central Hospital from October 2021 to June 2022 were selected as the GDM group,and 45 pregnant women with normal pregnancy examination and not diagnosed of GDM during the same period were selected as the control group.Logistic regression model was used to analyze the risk factors of GDM.The receiver operating characteristic curve(ROC)and calibration curve were used to evaluate the model.Results:Compared with the control group,the pre-pregnancy BMI,diabetes family history,fasting blood glucose,Hcy,T-BIL,LDL-C,FINS,HbA1c,PAI-1 activities of pregnant women in the diabetes group were significantly different(P<0.05).The distribution of PAI-1 gene alleles between two groups of pregnant women showed statistically significant differences(P<0.05).Logistic regression analysis showed that high fasting blood glucose(OR 2.583),high FINS(OR 1.984),high HbA1c(OR 4.258)and PAI-1 genotype(4G/4G)(OR 5.987)were independent risk factors for diabetes in pregnancy(P<0.05),and high T-BIL(OR 0.429)was a protective factor(P<0.05).The ROC curve and calibration curve showed that the model had good discrimination and calibration.There was a positive interaction between the PAI-1 genotype(4G/5G)and HbA1c≥8.0%,the PAI-1 genotype(4G/4G)and 6.0%≤HbA1c<8.0%,the PAI-1 genotype(4G/4G)and HbA1c≥8.0%(γ>1).Conclusions:PAI-1 gene polymorphism and HbA1c level in early pregnancy have synergistic interaction,which can promote the onset of diabetes in pregnancy.In clinical work,we should pay attention to the phenomenon that the PAI-1 genotype and HbA1c level of pregnant women increase,which is helpful to predict the occurrence of GDM.

关 键 词：纤溶酶原激活物抑制物-1 糖化血红蛋白 交互作用 妊娠期糖尿病 

分 类 号：R714.256[医药卫生—妇产科学]