血清丝氨酸蛋白酶抑制剂B1水平与妊娠期糖尿病发生风险的相关性研究

Study on the relationship between serum serine protease inhibitor B1 and gestational diabetes mellitus

目的探讨血清丝氨酸蛋白酶抑制剂B1(SerpinB1)与妊娠期糖尿病(GDM)发生风险的关系。方法回顾性分析2016年1月至2018年1月于中国医科大学附属盛京医院门诊就诊的328‌名孕妇,按GDM诊断标准分为血糖正常组(n=155)和GDM组(n=173)。采用酶联免疫吸附法测定孕5~12周、孕13~23周、孕24~28周、孕29~37周血清SerpinB1水平。筛选孕5~12周和孕13~23周时尚未发生GDM,而在孕24周及以后诊断GDM的孕妇作为GDM-A组(n=18)和GDM-B组(n=26)。应用多因素logistic回归对孕期影响GDM发生的相关因素进行分析。采用受试者工作特征(ROC)曲线预测孕期发生GDM的SerpinB1的最佳阈值。结果在孕5~12周、孕13~23周和孕24~28周时GDM组血清SerpinB1水平高于血糖正常组,差异有统计学意义(P<0.05)。孕24~28周血清SerpinB1水平与OGTT 0 min胰岛素、HOMA-IR呈负相关(r值分别为-0.724和-0.680,P<0.05),与LDL-C呈正相关(r=0.786,P<0.05)。校正妊娠年龄、孕前体质指数、黑棘皮征和甘油三酯等混杂因素后,孕13~23周血清SerpinB1水平仍是孕24周及以后发生GDM的独立危险因素,优势比(95%可信区间)为1.573(1.035~2.228),P<0.05。GDM-B组血清孕13~23周SerpinB1水平对预测孕24周及以后是否发生GDM有较好的预测效能,ROC下面积为0.631。结论孕13~23周血清SerpinB1水平的升高和孕24周及以后发生GDM相关,可能是GDM发生之前的血清学标志物。

Objective To explore the relationship between serum serine protease inhibitor B1(SerpinB1)and the risk of gestational diabetes mellitus(GDM).Methods A total of 328 pregnant women who were checked up in the clinic of Shengjing Hospital of China Medical University from 2016 to 2018 were divided into two groups according to GDM diagnostic criteria:normal(NC)group(n=155)and GDM group(n=173).The correlations between serum SerpinB1 level and glucose and lipid metabolism indexes were analyzed in 5-12 weeks,13-23 weeks,24-28 weeks and 29-37 weeks of pregnancy.The pregnant women who did not have GDM at 5-12 weeks of gestation but diagnosed GDM after 24 weeks of pregnancy were selected as GDM-A group(n=18).The pregnant women who did not have GDM at 13-23 weeks of gestation but diagnosed GDM after 24 weeks of pregnancy were selected as GDM-B group(n=26).Logistic regression was used to analyze the risk factors of GDM during pregnancy.Receiver operating characteristic(ROC)curve predicted the cut-off value of serum SerpinB1 levels affecting the occurrence of GDM after 24 weeks of pregnancy.Results In the GDM group,the serum SerpinB1 level at 5-12 weeks gestation,13-23 weeks gestation,24-28 weeks gestation of pregnancy was significantly higher than that in the NC group(P<0.05).At 24-28 weeks of gestation,the level of serum SerpinB1 was positively correlated with LDL-C(r=0.786,P<0.05)and negatively correlated with fasting insulin and HOMA-IR(r=-0.724 and-0.680 respectively,P<0.05).After correcting the confounding factors such as gestational age,pre-pregnant BMI,acanthosis nigricans and triglycerides,etc,serum SerpinB1 level at 13-23 weeks gestation was still an independent risk factor for GDM after 24 weeks of pregnancy(OR=1.573,95%CI was 1.035 to 2.228,P<0.05).The area under the ROC curve of GDM was 0.631(P<0.05).Conclusions Elevated serum SerpinB1 levels at 13-23 weeks of pregnancy is related to the risk of GDM occurrence after 24 weeks of pregnancy,which may be a serological marker before the occurrence of GDM.