妊娠期糖尿病患者血清神经调节蛋白4和Afamin水平变化及临床意义

Expressions and clinical significances of serum neuregulin 4 and afamin in patients with gestational diabetes mellitus

目的探讨妊娠期糖尿病(gestational diabetes mellitus, GDM)患者血清神经调节蛋白4(neuregulin 4, NRG4)和Afamin水平变化及临床意义。方法 GDM患者86例为GDM组,同期血糖正常孕妇209例为对照组。采用ELISA法检测2组血清NRG4、Afamin水平;多因素logistic回归分析GDM发生的影响因素;绘制ROC曲线评价血清NRG4、Afamin诊断GDM的效能。结果 GDM组血清NRG4[385.26(309.54, 532.42)ng/L]、Afamin[(113.69±24.35) mg/L]水平高于对照组[154.29(50.30, 285.46)ng/L、(83.48±17.27) mg/L](P<0.05)。多因素logistic回归分析结果显示,NRG4(OR=1.847,95%CI:1.108~3.078,P=0.019)、Afamin(OR=2.240,95%CI:1.231~4.077,P=0.008)是GDM发生的影响因素。ROC曲线分析结果显示,血清NRG4、Afamin分别以300.75 ng/L、92.03 mg/L为最佳截断值,诊断GDM的AUC分别为0.802(95%CI:0.744~0.860,P<0.001)、0.839(95%CI:0.787~0.891,P<0.001),灵敏度分别为81.40%、77.91%,特异度分别为77.99%、76.56%。结论 GDM患者血清NRG4、Afamin水平升高,可作为诊断GDM的生物标志物。

Objective To investigate the expressions and clinical significances of serum neuregulin 4(NGR4) and afamin in patients with gestational diabetes mellitus(GDM). Methods The serum NGR4 and afamin levels were detected by ELISA in 86 patients with GDM(GDM group) and 209 pregnant women with normal plasma glucose(control group). Multivariate logistic regression was used to analyze the influencing factors for GDM, and ROC was used to assess the efficacies of serum NGR4 and afamin levels on the diagnosis of GDM. Results The levels of NGR4 and afamin were significantly higher in GDM group((385.26(309.54, 532.42) ng/L,(113.69±24.35) mg/L) than those in control group((154.29(50.30, 285.46) ng/L,(83.48±17.27) mg/L)(P<0.05). The multivariate logistic regression analysis showed that NGR4(OR=1.847, 95%CI:1.108-3.078, P=0.019) and afamin(OR=2.240, 95%CI: 1.231-4.077, P=0.008) were the influencing factors for GDM. When the optimal cut-off values of NGR4 and afamin were 300.75 ng/L and 92.03 mg/L, the AUC values for diagnosing GDM were 0.802(95%CI: 0.744-0.860, P<0.001) and 0.839(95%CI:0.787-0.891, P<0.001), with sensitivities of 81.40% and 77.91%, and specificities of 77.99% and 76.56%, respectively. Conclusion The serum NGR4 and afamin levels are elevated, and could be used as the biomarkers for the diagnosis of GDM.