纤维蛋白单体水平在不同孕期变化与妊娠糖尿病的关系  

Relationship between fibrin monomer levels and gestational diabetes mellitus during different pregnancies

作　　者：杜会英 王梦楠 孙露 陈艳君 李芳芳 DU Huiying;WANG Mengnan;SUN Lu;CHEN Yanjun;LI Fangfang(Department of Obstetrics,Hengshui Maternal and Child Health Hospital,Hengshui,Hebei 053000,China;Clinical Laboratory,Hengshui Maternal and Child Health Hospital,Hengshui,Hebei 053000,China)

机构地区：[1]衡水市妇幼保健院产科,河北衡水053000 [2]衡水市妇幼保健院检验科,河北衡水053000

出　　处：《中国优生与遗传杂志》2023年第12期2478-2484,共7页Chinese Journal of Birth Health & Heredity

摘　　要：目的探究纤维蛋白单体水平在不同孕期的变化以及纤维蛋白单体水平和妊娠糖尿病的关系。方法将2021年11月至2022年11月于衡水市妇幼保健院做常规产前检查的妊娠孕产妇541例,作为研究对象。根据是否发生妊娠糖尿病,将研究对象分为妊娠糖尿病组(109例)和非妊娠糖尿病组(432例)。比较2组孕产妇不同孕期纤维蛋白单体、D-二聚体、空腹血糖、胰岛素抵抗水平的变化。多因素Logistic回归分析妊娠糖尿病的重要影响因素并构建人工神经网络模型。限制性立方样条估计纤维蛋白单体水平和妊娠糖尿病剂量-反应关系。评估纤维蛋白单体对妊娠糖尿病预测价值。结果在妊娠的不同时期,随着妊娠时间的增加,机体纤维蛋白单体、D-二聚体、空腹血糖、胰岛素抵抗表达水平呈现显著升高趋势。其中纤维蛋白单体的变化最显著。多因素分析显示,纤维蛋白单体、D-二聚体、空腹血糖、胰岛素抵抗是妊娠糖尿病的独立危险因素。限制性立方条模型分析显示,纤维蛋白单体和妊娠糖尿病呈非线性反应关系(非线性检验,P<0.001)。ROC曲线和累积增益图表明该模型预测能力良好。结论纤维蛋白单体作为独立变量可用于预测妊娠糖尿病发生。在妊娠妇女早孕期就要对纤维蛋白单体进行监测,以评估妊娠妇女妊娠糖尿病情况。Objective To explore the changes of fibrin monomer levels in different pregnancies and the relationship between fibrin monomer levels and gestational diabetes mellitus.Methods From November 2021 to November 2022,541pregnant women who underwent routine prenatal supervision examination in Hengshui Maternal and Child Care Service Centre were selected as the research objects.According to whether gestational diabetes mellitus occurred,the subjects were divided into gestational diabetes mellitus group(109 cases)and non-gestational diabetes mellitus group(432 cases).The changes of fibrin monomer,D-dimer,fasting blood glucose and insulin resistance were compared.Multivariate Logistic regression was used to analyze the important influencing factors of gestational diabetes mellitus and construct the artificial neural network model.Estimation of fibrin monomer levels and dose-response relationship in gestational diabetes with restricted cubic splines.The predictive value of fibrin monomer in gestational diabetes mellitus was evaluated.Results The expression levels of fibrin monomer,D-dimer,fasting blood glucose and insulin resistance increased significantly with the increase of gestation time.The changes of fibrin monomer were the most significant.The restricted cube model analysis showed nonlinear response relationship between fibrin monomer and gestational diabetes mellitus(nonlinear test,P<0.001).ROC curve showed that the expression level of fibrin monomer was a good predictor of gestational diabetes.Conclusion Fibrin monomer can be used as an independent variable to predict the occurrence of gestational diabetes mellitus.Fibrin monomers should be monitored during early pregnancy to assess gestational diabetes in pregnant women.

关 键 词：纤维蛋白单体 妊娠糖尿病 妊娠妇女 妊娠并发症 

分 类 号：R714.256[医药卫生—妇产科学]