补体Clq肿瘤坏死因子相关蛋白9和白细胞介素-6作为潜在生物指标预测妊娠期糖尿病的价值探讨

Value disscussion of Clq tumor necrosis factor related protein 9 and interleukin-6 as potential biomarkers in prediction of gestational diabetes mellitus

目的 观察中期妊娠血清补体Clq肿瘤坏死因子相关蛋白9(CTRP9)和白细胞介素-6(IL-6)水平变化及其作为潜在指标对妊娠期糖尿病(GDM)的预测价值.方法 选择2017年1月至2018年7月南京医科大学附属常州妇幼保健院和傈阳市妇幼保健院体检的孕16~20周妇女,以其中75例经75 g葡萄糖耐量试验(OGTT)最终诊断为GDM的孕妇为GDM组;75例没有发生GDM的孕妇为对照组.检测两组血清CTRP9和IL-6水平;计算体质量指数(BMI);采用Pearson相关分析法分析CTRP9与IL-6和BMI以及IL-6水平与BMI的相关性;绘制受试者工作特征曲线(ROC),分析CTRP9和IL-6作为潜在指标预测GDM的价值,并计算ROC曲线下面积(AUC).结果 与对照组比较,GDM组血清CTRP9水平明显降低(μg/L :110.4±38.5比130.5±45.2,P<0.05),血清IL-6水平和BMI明显升高[IL-6(ng/L):1.81±0.35比1.63±0.31,BMI(kg/m2):24.7±3.2比23.5±2.8,均P<0.05].相关性分析显示:GDM组CTRP9与IL-6和BMI均皇负相关(r1=-0.456, r2=-0.679,均P<0.05),IL-6与BMI皇正相关(r=0.716,P<0.05);对照组上述指标无相关性(均P>0.05).ROC曲线分析显示,CTRP9、IL-6对GDM均有一定的预测价值,CTRP9用于预测GDM的AUC为0.706,当诊断阈值为122.0 μg/L时,其敏感度和特异度分别为73.3%和61.3%,P=0.000;IL-6用于预测GDM的AUC为0.636,当诊断阈值为1.710 ng/L时,其敏感度和特异度分别为70.7%和54.7%,P=0.004.结论 GDM患者在妊娠16~20周血清CTRP9水平下降、IL-6水平升高,CTRP9和IL-6可能参与了GDM的发生发展,作为潜在指标预测GDM的发生具有一定价值.

Objective To observe the changes of serum C1q tumor necrosis factor related protein 9(CTRP9)and interleukin-6(IL-6)concentrations in the second trimester of pregnant and their values in predicting gestational diabetes mellitus(GDM)as potential biomarkers.Methods From January 2017 to July 2018,pregnant women for physical examination at 16-20 gestational weeks in Changzhou Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University and Liyang Maternal and Child Health Hospital were selected.Among them 75 pregnant women diagnosed as gestational diabetes mellitus(GDM)by 75 g glucose tolerance test(OGTT)were selected as the GDM group,and 75 pregnant women without GDM were selected as the control group.Serum CTRP9 and IL-6 levels were detected and body mass index(BMI)was calculated.Pearson correlation analysis was used to analyze the correlation between serum CTRP9 and IL-6,BMI,as well as IL-6 level and BMI.The receiver operating characteristic curve(ROC)was drawn,the value of CTRP9 and IL-6 as potential indicators to predict GDM was analyzed,and the area under curve(AUC)of ROC was calculated.Results Compared with the control group,the concentration of serum CTRP9 in the GDM group decreased(μg/L:110.4±38.5 vs.130.5±45.2,P<0.05),serum IL-6 level and BMI increased[IL-6(ng/L):1.81±0.35 vs.1.63±0.31,BMI(kg/m^2):24.7±3.2 vs.23.5±2.8,both P<0.05].Correlation analysis showed that CTRP9 in the GDM group was negatively correlated with serum IL-6 and BMI(r1=-0.456,r^2=-0.679,both P<0.05),there was a positive correlation between IL-6 level and BMI(r=0.716,P<0.05);there was no correlation between the above indicators in the control group(all P>0.05).ROC curve analysis showed that both CTRP9 and IL-6 had certain predictive value for GDM,the AUC of CTRP9 used to predict GDM was 0.706,and when the diagnostic threshold was 122.0μg/L,the sensitivity and specificity were 73.3%and 61.3%,respectively,P=0.000.The AUC of IL-6 used to predict GDM was 0.636,and when the diagnostic threshold was 1.710 ng/L,the sensitivity and specificity were 70.7%and 54.7%,respectively,P=0.004.Conclusions In patients with GDM,the serum CTRP9 concentration decreased and IL-6 concentration increased during 16 to 20 weeks of pregnancy.CTRP9 and IL-6 may be involved in the occurrence and development of GDM, and have certain value as potential biomarkers to predict the occurrence of GDM.