脂肪因子水平与妊娠期糖尿病患者母婴结局的相关性分析

Correlation Analysis between Adipokine Levels and Maternal and Neonatal Outcomes in Patients with Gestational Diabetes Mellitus

目的探讨血清脂肪因子水平与妊娠期糖尿病(GDM)患者母婴结局的相关性。方法选取医院2014年3月-2017年3月收治的GDM患者102例,所有患者均在入院当天采血检测脂肪因子水平,包括血清脂肪细胞型脂肪酸结合蛋白(AFABP)、视黄醇结合蛋白4(RBP4)、瘦素、脂联素。根据妊娠结局将无不良结局者分成结局良好组(n=79),将出现胎膜早破、巨大儿、新生儿窒息等不良事件者作为不良结局组(n=23),比较两组年龄、孕期体质量(BMI)、子痫前期、孕期血糖控制、羊水过多、产次以及血清脂肪因子水平。采用ROC曲线分析脂肪因子水平对GDM患者不良妊娠结局的预测价值,利用Logistic回归分析明确GDM患者不良妊娠结局的独立危险因素。结果结局良好组的年龄≥35岁、孕期体质量≥28kg、有子痫前期占比均低于不良结局组,且结局良好组的血清AFABP、RBP4、瘦素水平低于不良结局组,血清脂联素水平高于不良结局组,差异有统计学意义(P<0.05)。血清AFABP、RBP4、瘦素、脂联素预测GDM患者不良妊娠结局的曲线下面积分别为0.772、0.754、0.796、0.821。经Logistic回归分析显示年龄(≥35岁)、孕期体质量(≥28kg/m^2)、孕期血糖(控制良好)、有子痫前期、AFABP(>30.475μg/L)、RBP4(>47.700mg/L)、瘦素(>8.449μg/L)、脂联素(<4.644mg/L)是GDM患者不良妊娠结局的独立危险因素(P<0.05)。结论脂肪因子水平与GDM母婴结局密切相关,其中血清AFABP、RBP4、瘦素与不良妊娠结局呈正相关,血清脂联素与不良妊娠结局呈负相关。

Objective To investigate the correlation between serum adipokine levels and maternal and neonatal outcomes in patients with gestational diabetes mellitus. Methods 102 cases of GDM admitted to our hospital from March 2014 to March 2017 were selected.All patients were collected on the day of admission to detect the level of fat factor, including serum adipocyte fatty acid binding protein, retinol binding protein 4, leptin,adiponectin.The undesirable outcome group was divided into good outcome group(n=79) according to the outcome of pregnancy, and the adverse event group such as premature rupture of membranes, giant infants and asphyxia neonatorum would be found as adverse outcome group(n=23). Age, gestational body mass,preeclampsia, gestational blood glucose control, amniotic fluid, parity and serum adipokines were compared between the two groups.Prediction of adverse pregnancy outcomes in patients with GDM by ROC curve analysis.Logistic regression analysis was used to identify the independent risk factors of adverse pregnancy outcomes in GDM patients. Results The group with a good outcome over the age of 35 years, a body weight of more than 28 KG during pregnancy, and a preeclampsia ratio were all lower than those in the adverse outcome group.The serum AFABP, RBP4 and leptin levels in the group with good outcome were lower than those in the adverse outcome group, and the serum adiponectin level was higher than that in the adverse outcome group.The difference was statistically significant(P<0.05).The area under the curve of serum AFABP, RBP4, leptin and adiponectin in predicting the adverse pregnancy outcomes of GDM patients was 0.772, 0.754, 0.796 and0.821.Logistic regression analysis showed that age(≥ 35 years), body mass(≥28 kg/m^2), pregnancy glucose(good control), preeclampsia, AFABP(> 30.475μg/L),RBP4(> 47.700 mg/L), leptin(> 8.449μg/L), and adiponectin(<4.644 mg/L) were independent risk factors of bad pregnancy outcome in patients with GDM.(P<0.05). Conclusions Adipokine levels were closely related to the maternal and neonatal outcomes of GDM, and serum AFABP, RBP4 and leptin were positively correlated with adverse pregnancy outcomes. Negative correlation between serum adiponectin and bad pregnancy outcome.