摘要
目的探讨血清miR-135-5p和叉头框蛋白N3(FOXN3)水平对妊娠期糖尿病(GDM)孕妇妊娠结局的影响。方法前瞻性选取2023年1月至2024年9月在该院定期检查和分娩的GDM孕妇153例作为GDM组,同时选取在该院产检的健康孕妇112例为对照组,依据GDM孕妇是否发生不良妊娠结局,将其分为结局良好组(n=94)和结局不良组(n=59)。对比不同组间血清miR-135-5p和FOXN3及脂代谢和糖代谢指标水平,采用Pearson相关分析miR-135-5p、FOXN3水平与脂代谢、糖代谢指标的相关性,多因素logistic回归分析GDM患者发生不良妊娠结局的影响因素,采用受试者工作特征(ROC)曲线分析miR-135-5p、FOXN3水平对GDM患者发生不良妊娠结局的预测价值。结果GDM组孕期体重增加值明显低于对照组(P<0.05);GDM组患者血清中miR-135-5p、FOXN3、TG、TC、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、空腹血糖(FBG)及稳态模型评估胰岛素抵抗指数(HOMA-IR)明显高于对照组(P<0.001),稳态模型评估胰岛β细胞功能指数(HOMA-β)低于对照组(P<0.001);结局不良组患者血清中miR-135-5p、FOXN3、TG、TC、HbA1c、FINS、FBG及HOMA-IR明显高于结局良好组,HOMA-β低于结局良好组(P<0.001);血清miR-135-5p与FOXN3、TG、TC、HbA1c、FINS、FBG及HOMA-IR均呈正相关(r=0.479、0.327、0.412、0.394、0.501、0.305、0.512,P<0.05),与HOMA-β呈负相关性(r=-0.424,P<0.05);血清FOXN3与TG、TC、HbA1c、FINS、FBG及HOMA-IR均呈正相关性(r=0.405、0.441、0.376、0.513、0.347、0.297,P<0.05),与HOMA-β呈负相关性(r=-0.392,P<0.05)。logistic回归分析结果显示,miR-135-5p、FOXN3、TG、HbA1c、FINS、HOMA-IR和HOMA-β为GDM患者发生不良妊娠结局的影响因素(P<0.05)。miR-135-5p预测GDM患者发生不良妊娠结局的曲线下面积(AUC)为0.874,灵敏度为82.98%,特异度为72.88%;FOXN3预测GDM患者发生不良妊娠结局的AUC为0.813,灵敏度为77.60%,特异度为68.97%;二者联合预测GDM患者发生不良妊娠结局的AUC为0.931,灵敏度为84.48%,特异度为74.47%,二者联合检测的诊断价值优于miR-135-5p、FOXN3各自单独预测(P<0.05)。结论GDM孕妇血清中miR-135-5p和FOXN3水平升高,二者联合检测对GDM孕妇发生不良妊娠结局具有较高的预测价值。
Objective To investigate the influence of serum miR-135-5p and FOXN3 levels on the pregnant outcomes of pregnant women with gestational diabetes mellitus(GDM).Methods A total of 153 pregnant women with GDM visiting in this hospital for the regular examination and delivery from January 2023 to September 2024 were prospectively selected as the GDM group,meanwhile 112 healthy pregnant women for prenatal examination in this hospital were selected as the control group.According to whether the pregnant women with diabetes had adverse perinatal outcomes,they were divided into the good outcome group(94 cases)and adverse outcome group(59 cases).The levels of serum miR-135-5p and FOXN3,lipid metabolic and glucose metabolic indicators were compared between the different groups.The Person correlation was used to analyze the correlation between miR-135-5p and FOXN3 levels with lipid and glucose metabolism indicators.The multivariate logistic regression was used to analyze the influencing factors of adverse perinatal outcomes in GDM patients.The receiver operating characteristic(ROC)curves were used to analyze the predictive value of miR-135-5p and FOXN3 levels on adverse perinatal outcomes occurrence in GDM patients.Results The weight gain value during pregnancy in the GDM group was significantly lower than that in the control group(P<0.05);the levels of serum miR-135-5p,FOXN3,TG,TC,HbA1c,FINS,FBG,HOMA-IR in the patients of the GDM group were significantly higher than those in the control group(P<0.001);while the HOMA-βlevel was lower than that in the control group(P<0.001);the levels of serum miR-135-5p,FOXN3,TG,TC,HbA1c,FINS,FBG and HOMA-IR in the patients with adverse outcomes group were significantly higher than those in the good outcomes group,while the HOMA-βlevel was significantly lower than that in the adverse outcomes group(P<0.001);serum miR-135-5p was positively correlated with FOXN3,TG,TC,HbA1c,FINS,FBG and HOMA-IR(r=0.479,0.327,0.412,0.394,0.501,0.305,0.512,P<0.05),and negatively correlated with HOMA-β(r=-0.424,P<0.05);serum FOXN3 was positively correlated with TG,TC,HbA1c,FINS,FBG,and HOMA-IR(r=0.405,0.441,0.376,0.513,0.347,0.297,P<0.05),and negatively correlated with HOMA-β(r=-0.392,P<0.05).The results of logistic regression analysis showed that miR-135-5p,FOXN3,TG,HbA1c,FINS,HOMA-IR and HOMA-βwere the influencing factors of adverse perinatal outcomes occurrence in GDM patients(P<0.05);the area under the curve(AUC)of miR-135-5p for predicting the adverse perinatal outcomes in GDM patients was 0.874,the sensitivity was 82.98%and the specificity was 72.88%;the AUC of FOXN3 for predicting the adverse perinatal outcomes occurrence in GDM patients were 0.813,the sensitivity was 77.60%and the specificity was 68.97%,respectively;the AUC of the two combination for predicting the adverse perinatal outcomes occurrence in GDM patients were 0.931,the sensitivity was 84.48%and the pecificity was 74.47%respectively.The diagnostic value of the two combination was superior to that of miR-135-5p and FOXN3 alone(both P<0.05).Conclusion The levels of serum miR-135-5p and FOXN3 in pregnant women with GDM are increased.Their combination detection has high predictive value for the adverse perinatal outcomes occurrence in GDM pregnant women.
作者
袁晓雯
罗婷
YUAN Xiaowen;LUO Ting(Department of Obstetrics,Obstetrics and Gynecology Hospital of TongJi University,Shanghai 200040,China)
出处
《重庆医学》
2026年第1期184-189,共6页
Chongqing Medical Journal
