孕早期血清转化生长因子-β1、铁蛋白水平预测妊娠期糖尿病孕晚期骨质疏松的价值

The value of serum transforming growth factor-β1 and ferritin levels in early pregnancy in predicting osteoporosis in late pregnancy of gestational diabetes mellitus

目的探讨孕早期血清转化生长因子-β1(transforming growth factor beta 1,TGF-β1)、铁蛋白(ferritin,SF)水平预测妊娠期糖尿病(gestational diabetes mellitus,GDM)患者孕晚期发生骨质疏松的价值。方法纳入2022年1月至2023年6月于青岛市市立医院建卡、检查及分娩的162例GDM孕妇作为研究对象,根据孕晚期时是否发生骨质疏松,将所有GDM孕妇分为骨质疏松组(28例)和非骨质疏松组(134例)。检测并记录孕妇的孕早期血清TGF-β1及SF水平,孕晚期的骨密度和骨代谢指标25-维生素D3[25-(OH)D3]、Ⅰ型胶原交联C-末端肽(typeⅠcollagen carboxy-terminal peptide,CTX),Ⅰ型前胶原氨基末端肽(typeⅠprocollagenamino-terminal peptide,PINP)水平,采用ELISA法检测抗酒石酸酸性磷酸酶(tartrate resistant acid phosphatase,TRACP)水平。结果骨质疏松组孕妇的25-(OH)D3水平为21.45±3.62,相较于非骨质疏松组的25.61±3.84显著降低(t=5.37,P<0.001);骨质疏松组孕妇TRACP为4.72±0.63,相较于非骨质疏松组的4.24±0.71显著升高(t=4.35,P<0.001)。相较于非骨质疏松组,骨质疏松组孕妇的血清TGF-β1水平显著降低(8.42±1.30 vs.9.67±1.45),SF水平显著升高(192.25±20.21 vs.178.36±22.18),差异有统计学意义(t=4.54、3.98,P<0.001)。骨质疏松孕妇血清TGF-β1水平与25-(OH)D_(3)呈显著正相关关系(r=0.43,P=0.007),与TRACP呈显著负相关关系(r=-0.55,P<0.001);血清SF水平与25-(OH)D 3呈显著负相关关系(r=-0.38,P=0.016),与TRACP、PINP呈显著正相关关系(r=0.44、0.34,P=0.004、0.028)。ROC曲线分析结果显示,血清TGF-β1、SF水平预测GDM孕妇孕晚期骨质疏松的的曲线下面积分别为0.825(0.748~0.901)、0.808(0.730~0.885),灵敏度和特异度分别为78.6%和75.4%、96.4%和60.4%,两者联合预测的曲线下面积为0.880(0.810~0.951),灵敏度和特异度分别为85.7%和84.3%。结论孕早期血清TGF-β1及SF水平对GDM患者孕晚期发生骨质疏松有关,并有一定预测价值,应重视骨质疏松高危孕妇的早期预防。

Objective To investigate the value of serum transforming growth factor-β1(TGF-β1)and ferritin(SF)levels in early pregnancy in predicting osteoporosis in patients with gestational diabetes mellitus(GDM)in late pregnancy.Methods A total of 162 pregnant women with gestational diabetes who were registered,examined and delivered in our hospital from Jan.2022 to Jun.2023 were included as research objects.According to whether osteoporosis occurred in the third trimester,all pregnant women with gestational diabetes were divided into osteoporosis group(28 women)and non-osteoporosis group(134 women).Serum TGF-β1 and SF levels in the first trimester,bone mineral density and bone metabolism indicators 25-vitamin D3[25-(OH)D3],typeⅠcollagen carboxy-terminal peptide(CTX),typeⅠprocollagenamino-terminal peptide(PINP)were detected and recorded.The level of tartrate-resistant acid phosphatase(TRACP)was detected by ELISA.Results Compared with the non-osteoporosis group,the level of 25-(OH)D3 in the osteoporosis group was significantly decreased(21.45±3.62 vs.25.61±3.84),and the TRACP was significantly increased(4.72±0.63 vs.4.24±0.71),and the differences were statistically significant(t values were 5.37 and 4.35,respectively).The P-values were<0.001).Compared with the non-osteoporosis group,the serum TGF-β1 level in the osteoporosis group was significantly decreased(8.42±1.30 vs.9.67±1.45),and SF level was significantly increased(192.25±20.21 vs.178.36±22.18).The difference was statistically significant(tvalues were 4.54 and 3.98,and P-values were<0.001,respectively).The serum TGF-β1 level was positively correlated with 25-(OH)D3(r=0.43,P=0.007.),and negatively correlated with TRACP(r=-0.55,P<0.001).Serum SF level was negatively correlated with 25-(OH)D3(r=-0.38,P=0.016),and positively correlated with TRACP and PINP(r=0.44 and 0.34,P=0.004 and 0.028,respectively).ROC curve analysis results showed that the area under the curve of serum TGF-β1 and SF levels in predicting osteoporosis in late pregnancy was 0.825(0.748-0.901)and 0.808(0.730-0.885),respectively.The sensitivity and specificity were 78.6%and 75.4%,96.4%and 60.4%,respectively.The area under the curve was 0.880(0.810-0.951),and the sensitivity and specificity were 85.7%and 84.3%,respectively.Conclusion Serum TGF-β1 and SF levels in the first trimester of pregnancy are associated with osteoporosis in the third trimester of GDM,and have certain predictive value.