妊娠期糖尿病孕妇脂联素的表达和意义

Expression and Meaning of Adiponectin in Pregnant Women With Gestational Diabetes Mellitus

目的探讨脂联素(Adiponectin,APN)对妊娠期糖尿病(Gestational diabetes mellitus,GDM)的早期预测价值和相关性。方法选取2015年10月—2016年9月在福建省妇幼保健院产检的GDM及正常孕妇各100例。分别于孕早期(10～12周)、孕中期(24～28周)和孕晚期(36～38周)检测孕妇血清APN、胰岛素及血糖。比较孕早、中、晚期APN水平,探讨孕早期APN对GDM的预测价值。结果 (1)GDM组不同阶段APN均低于对照组,而血糖、胰岛素、HOMA-IR高于对照组(P<0.05)。(2)GDM组孕中期APN与OGTT1、OGTT2、FINS和HOMAIR均呈负相关(r=-0.675、-0.346、-0.490、-0.398, P <0.01);对照组血清APN与其它指标无显著相关性。(3)孕早期血清APN预测GDM曲线结果:AUCROC为0.900,95%CI为0.855-0.945。当临界值为8.91μg/ml时,其诊断GDM敏感性为93%,特异性为80%,阳性预测值为91.95%,阴性预测值为82.30%,Youden指数为0.73。当孕早期APN <8.91μg/ml时,GDM的发生风险增高。结论孕期APN水平与GDM的发生相关,孕早期APN预测GDM有一定的价值。

Objective To explore the correlation and early prediction valuebetween APN and GDM. Methods From October 2015 to September 2016,100 GDM and 100 normal pregnancies were involved . Serum APN, insulinlevels and blood glucose were detected respectively in the first trimester （10to 12 weeks） , the second trimester （24 to 28 weeks） and the third trimester（36 to 38 weeks）of pregnancy. Serum APN level at different stages,evaluated predictive value of serum APN at the first trimester for GDMwere analyzed. Results （1）Serum APN of different stage of GDM groupwas lower than the control group, while glucose, FINS, HOMA IR werehigher than the control group （P 〈 0.05）. （2）For GDM pregnancies, in thesecond trimester,was negatively correlated with OGTT1, OGTT2, FINS andHOMA-IR （r = -0.675, -0.346, -0.490, -0.398, P 〈 0.01）.The control grouphad no significant correlation between serum APN and other indicators.3.In the first trimester , serum APN predict GDM curve AUCROC was 0.900,95%CI was 0.855-0.945.When the cut off value of APN was 8.91 μg/ml, the sensitivity specificity, positive predictive value, negative predictive valueand Youden index was 93%, 80%, 91.95%, 82.30% and 0.73 respectively.It significantly increased the risk of GDM when APN 〈 8.91 g/ml was firsttrimester. Conclusion Serum APN level was associated with GDM, and inthe first trimester has certain prediction value for GDM.