IL-6和CRP及TNF-α在妊娠期糖尿病合并高血压孕妇中的表达水平及意义

The expression and significance of IL-6,CRP and TNF-α in pregnant women with gestational diabetes and hypertension

目的探究白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)在妊娠期糖尿病(GDM)合并高血压孕妇中的表达及意义。方法选取2018年1月-2021年1月三门峡市中医院确诊的80例GDM孕妇作为研究对象,根据患者是否合并妊娠期高血压(PIH)分为GDM-PIH组(n=26)和GDM组(n=54),另选取正常孕妇30名作为对照组。采用酶联免疫吸附法(ELISA)检测血清IL-6、TNF-α水平,采用免疫散射比浊法检测血清CRP水平并进行比较,采用受试者工作特征曲线(ROC)评估诊断效能,建立logistic回归模型进行多因素分析,比较血清IL-6、TNF-α、CRP水平对新生儿Apgar评分的影响。结果GDM组孕妇血清IL-6、CRP、TNF-α水平明显高于对照组,而GDM-PIH组孕妇上述指标水平明显高于GDM组,差异有统计学意义(P<0.05);血清IL-6、CRP、TNF-α水平均为GDM孕妇合并PIH的独立危险因素(OR>1,P<0.05);血清IL-6对GDM-PIH的诊断曲线下面积(AUC)为0.813,血清CRP对GDM-PIH的诊断AUC为0.716,血清TNF-α对GDM-PIH的诊断AUC为0.745,而三者联合诊断AUC为0.947,诊断效能优于单项(P<0.05);血清IL-6、CRP、TNF-α低表达组新生儿1、5和10 min Apgar评分均高于高表达组,差异有统计学意义(P<0.05)。结论IL-6、CRP、TNF-α在GDM-PIH孕妇血清中水平升高,可导致新生儿Apgar评分降低,是GDM-PIH发生的独立危险因素,能够作为GDM-PIH的早期诊断指标。

Objective To explore the expression and significance of interleukin-6(IL-6),C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)in pregnant women with gestational diabetes mellitus(GDM)and hypertension.Methods Eighty pregnant women with GDM diagnosed in our hospital from January 2018 to January 2021 were selected as the research objects.According to whether the patients were combined with pregnancy induced hypertension syndrome(PIH),they were divided into GDM-PIH group(n=26)and GDM group(n=54),and 30 normal pregnant women were selected as the control group.Enzyme-linked immunosorbent assay(ELISA)was used to detect serum IL-6 and TNF-αlevels;immunoscattering turbidimetric method was used to detect serum CRP levels.The receiver operating characteristic curve(ROC)was used to evaluate the diagnostic efficacy.Logistic regression model was used for multivariate analysis to compare the effects of serum IL-6,TNF-α,and CRP levels on the Apgar score of newborns.Results Serum IL-6,CRP,and TNF-αlevels of pregnant women in the GDM group were significantly higher than those of the control group,while the above-mentioned index levels of pregnant women in the GDM-PIH group were significantly higher than those in the GDM group(P<0.05);serum IL-6,CRP and TNF-αlevels were all independent risk factors for GDM pregnant women with PIH(OR>1,P<0.05);the diagnostic area under the curve(AUC)of serum IL-6 for GDM-PIH was 0.813;the diagnostic AUC of serum CRP for GDM-PIH was 0.716,and the diagnostic AUC of serum TNF-αfor GDM-PIH was 0.745,while the combined diagnostic AUC of the three was 0.947,and the diagnostic efficiency was better than single item(P<0.05).The Apgar scores at 1,5 and 10 min in the low expression group of serum IL-6,CRP and TNF-αwere significantly higher than those in the high expression group(P<0.05).Conclusions The levels of IL-6,CRP,and TNF-αin the serum of GDMPIH pregnant women were elevated,which could lead to a decrease in the Apgar score of newborns.They were independent risk factors for the occurrence of GDM-PIH and could be used as early diagnostic indicators for GDM-PIH.