摘要
目的 探究孕早期妊娠相关血浆蛋白A(PAPP-A)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、载脂蛋白CⅢ(ApoCⅢ)及纤维凝胶蛋白-3(Ficolin-3)水平对妊娠期糖尿病(GDM)的预测价值。方法 选取2019年2月至2020年2月在中国人民解放军联勤保障部队第920医院建档产检的孕早期(孕7~13周)孕妇为研究对象,于孕24~28周时行口服75g葡萄糖耐量试验(OGGT)检查,在确诊的GDM患者中随机选取45例为观察组,在产检健康的正常孕妇中随机选取50例为对照组。比较两组PAPP-A、NGAL、ApoCⅢ及Ficolin-3水平的差异,并用受试者工作特征(ROC)曲线分析以上指标对孕妇GDM的早期预测价值。结果 观察组的年龄、孕前体质量指数(BMI)均高于对照组(t值分别为2.810、3.048,P<0.05)。与对照组相比,观察组的PAPP-A中位数倍数(MoM)更低,而NGAL、ApoCⅢ及Ficolin-3水平均更高(t值分别为4.437、7.898、6.173、3.195,P<0.05)。在多因素Logistic回归分析中,孕妇的年龄、孕前BMI、PAPP-A MoM、NGAL、ApoCⅢ、Ficolin-3均为GDM的独立影响因素(OR值分别为0.855、0.633、0.000、0.461、0.672、0.944,P<0.05)。在ROC分析中,孕早期PAPP-A、NGAL、ApoCⅢ及Ficolin-3水平均对GDM具有一定的预测价值(曲线下面积分别为0.885、0.836、0.810、0.720;灵敏度分别为0.911、0.644、0.689、0.800;特异度分别为0.780、0.920、0.960、0.580),其中PAPP-A、NGAL、ApoCⅢ的曲线下面积均在0.8以上,预测具有一定的准确性。结论 孕早期PAPP-A、NGAL、ApoCⅢ及Ficolin-3水平对孕妇后期血糖变化及GDM生成具有明显的影响,对GDM具有潜在的预测价值,孕妇产检早期需加以重视,经临床验证后应采取针对性的控制措施。
Objective To investigate predictive values of levels of pregnancy-associated plasma protein A(PAPP-A),neutrophil gelatinase-associated lipocalin(NGAL),apolipoprotein CⅢ(ApoCⅢ) and fibrin glue-3(Ficolin-3) in early pregnancy for gestational diabetes mellitus(GDM).Methods The pregnant women in the first trimester(7-13 weeks) who were registered and received regular prenatal examination in No.920 Hospital, The Joint Logistic Support Force of P.L.A from February 2019 to February 2020 were selected as study subjects.The fasting venous blood samples of the pregnant women at 7-13 weeks of gestation were collected.ELASA was used to detect PAPP-A,NGAL,ApoCⅢ and Ficolin-3 levels of the early pregnant women.At 24 to 28 weeks of gestation, all the pregnant women were given 75 g of glucose for oral glucose tolerance test(OGTT),45 patients with confirmed GDM were randomly selected and divided into the observation group, and 50 healthy normal pregnant women were randomly selected and divided into the control group.The levels of PAPP-A,NGAL,ApoCⅢ and Ficolin-3 of the pregnant women were compared between the two groups, and the receiver operating characteristic(ROC) curve was used to analyze predictive values of the four indexes for GDM.Results The age and pregestational BMI of the pregnant women in the observation group were higher than those in the control group, and the differences were both statistically significant(t=2.810 and 3.048 respectively, both P<0.05).Compared with the pregnant women in the control group, the multiplicity of median(MoM) of PAPP-A of the pregnant women in the observation group was lower, while the levels of NGAL,ApoCⅢ and Ficolin-3 were higher, and there were statistical differences between the two groups(t=4.437,7.898,6.173 and 3.195 respectively, all P<0.05).Multivariate Logistic regression analysis showed that pregnant women′s age, pregestational BMI,PAPP-A MoM,NGAL,ApoCⅢ and Ficolin-3 were all independent influencing factors of GDM(OR=0.855,0.633,0.000,0.461,0.672 and 0.944 respectively, all P<0.05).ROC analysis showed that the levels of PAPP-A,NGAL,ApoCⅢ and Ficolin-3 in early pregnancy had certain predictive values for GDM(AUC=0.885,0.836,0.810 and 0.720 respectively, the sensitivities were 0.911,0.644,0.689 and 0.800 respectively, and the specificities were 0.780,0.920,0.960 and 0.580 respectively).Of which, the AUCs of PAPP-A,NGAL and ApoCⅢ were all more than 0.8,suggesting that their predictive values had some accuracy.Conclusion The PAPP-A、NGAL、ApoCⅢ and Ficolin-3 levels in early pregnancy are associated with occurrence of GDM in late pregnancy, and have potential predictive values for GDM.More attention should be paid to the levels of PAPP-A,NGAL,ApoCⅢ and Ficolin-3 of the early pregnant women in prenatal examination, and targeted blood glucose control measures should be taken after clinical verification of GDM.
作者
何慧梅
李丽凤
阮兆娟
鞠海兵
周士林
HE Huimei;LI Lifeng;RUAN Zhaojuan;JU Haibing;ZHOU Shilin(Department of Endocrinology;Department of Gynecology and Obstetrics,No.920 Hospital of The Joint Logistic Support Force of The People′s Liberation Army,Yunnan Kunming 650032,China)
出处
《中国妇幼健康研究》
2022年第5期20-25,共6页
Chinese Journal of Woman and Child Health Research
关键词
妊娠期糖尿病
孕早期
预测
妊娠相关血浆蛋白A
gestational diabetes mellitus(GDM)
early pregnancy
prediction
pregnancy-associated plasma protein A(PAPP-A)
