血清Ghrelin、VEGF-A水平对妊娠期糖尿病患者早发型胎儿生长受限的预测价值  

Predictive value of serum Ghrelin and VEGF-A levels in early onset fetal growth restriction in patients with gestational diabetes mellitus

作　　者：陈丽 卢国萍 刘芙蓉 CHEN Li;LU Guoping;LIU Furong(Department of Internal Medicine,Hainan Women and Children's Medical Center,Haikou 571100,China;Department of Critical Care Medicine,Hainan Women and Children's Medical Center,Haikou 571100,China)

机构地区：[1]海南省妇女儿童医学中心内科,海口571100 [2]海南省妇女儿童医学中心重症医学科,海口571100

出　　处：《新疆医科大学学报》2024年第5期699-703,共5页Journal of Xinjiang Medical University

基　　金：海南省卫生计生行业科研项目(22A220031)。

摘　　要：目的探讨血清生长激素释放多肽(Ghrelin)、血管内皮生长因子-A(Vascular endothelial growth factor-A,VEGF-A)水平对妊娠期糖尿病(Gestational diabetes mellitus,GDM)患者早发型胎儿生长受限(Fetal growth restriction,FGR)的预测价值。方法选取2020年3月至2022年3月在海南省妇女儿童医学中心进行产前检查并分娩的GDM患者为研究对象,根据胎儿体重分为FGR组(n=26)、正常组(n=82)和巨大儿组(n=18)。比较3组血清Ghrelin、VEGF-A水平,并采用Pearson相关系数法分析两指标与胎儿体重的相关性,并绘制受试者工作特征(Receiver operating characteristic curve,ROC)曲线分析血清Ghrelin、VEGF-A对GDM孕妇发生早发型FGR的预测价值。结果131例GDM孕妇不良妊娠结局总发生率为37.40%(49/131),其中巨大儿18例、FGR 26例。正常组空腹血糖水平、剖宫产占比均低于FGR组、巨大儿组,FGR组与巨大儿组空腹血糖水平、剖宫产占比比较,差异无统计学意义(P>0.05)。与巨大儿组相比,FGR组和正常组孕妇血清Ghrelin水平偏高,且FGR组高于正常组,而FGR组和正常组VEGF-A水平偏低,且FGR组VEGF-A水平低于正常组(P<0.05)。Pearson相关性分析显示,血清Ghrelin与胎儿出生体重呈负相关(r=-0.677,P<0.05),VEGF-A与胎儿出生体重呈正相关(r=0.690,P<0.05)。ROC曲线显示,血清Ghrelin、VEGF-A单独预测GDM孕妇发生早发型FGR的曲线下面积(Area under curve,AUC)分别为0.672、0.755,联合预测AUC为0.848,联合预测效能较单独预测效能更好(P<0.05)。结论GMD孕妇体内血清Ghrelin、VEGF-A水平与胎儿体重具有相关性,是早发型FGR的预测标志物,且两者联合预测GMD孕妇早发型FGR临床价值更高。Objective To investigate the predictive value of serum levels of Ghrelin and vascular endothelial growth factor-A(VEGF-A)in early-onset fetal growth restriction(FGR)in patients with gestational diabetes mellitus(GDM).Methods GDM patients who underwent prenatal examination and delivered in Hainan women's and children's medical center from March 2020 to March 2022 were selected asthe study objects,and could be divided into FGR group(n=26),normal group(n=82)and macrosomia group(n=18)according to fetal weight.Serum Ghrelin and VEGF-A levels were compared among the three3 groups,and Pearson correlation coefficient method was used to analyze the correlation between the two 2 indexes and fetal weight,and receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of serum Ghrelin and VEGF-A on the occurrence of early-onset FGR in pregnant women with GDM.Results The total incidence of adverse pregnancy outcome in 131 GDM women was 37.40%(49/131),including 18 macrosomia cases and 26 FGR cases.The fasting blood glucose level and the proportion of cesarean section in normal group were lower than those in FGR group and macrosomia group,but there was no significant difference between FGR group and macrosomia group(P>0.05).Compared with macrosomia groups,the serum Ghrelin level in FGR group and normal group was higher than normal group,the VEGF-A level in FGR group and normal group was lower,and the VEGF-A level in FGR group was lower than normal group(P<0.05).Pearson correlation analysis showed that serum Ghrelin was negatively correlated with fetal birth weight(r=-0.677,P<0.05),and VEGF-A was positively correlated with fetal birth weight(r=0.690,P<0.05).ROC curve showed that the AUC of serum Ghrelin and VEGF-A alone in predicting the occurrence of early-onset FGR in pregnant women with GDM was 0.672 and 0.755,respectively,and the AUC of combined prediction was 0.848.The combined prediction efficiency was better than that of single prediction(P<0.05).Conclusion Serum Ghrelin and VEGF-A levels in GMD

关 键 词：妊娠期糖尿病 早发型胎儿生长受限 生长激素释放多肽 血管内皮生长因子-A 

分 类 号：R714.5[医药卫生—妇产科学]