血清Nesfatin-1及炎性因子水平对妊娠期糖尿病的早期临床预测价值

Early clinical predictive value of nesfatin-1 and inflammatory cytokines in gestational diabetes mellitus

为探讨血清摄食抑制因子1(Nesfatin-1)、IL-6、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、TNF-α、脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,LP-PLA2)对妊娠期糖尿病(gestational diabetes mellitus,GDM)的早期预测价值,随取43例GDM患者(GDM组)、51例糖耐量正常孕妇(normal glucose tolerance, NGT)(NGT组)、40例健康未孕妇女(对照组)为研究对象。采集各组静脉血检测血清Nesfatin-1、IL-6、hs-CRP、TNF-α、LP-PLA2水平,分析上述指标与胰岛素抵抗(homeostasis model assessment insulin resistance,HOMA-IR)、糖脂代谢指标的关系以及其对GDM的预测价值。结果显示,GDM组血清Nesfatin-1、IL-6、hs-CRP、TNF-α、LP-PLA2水平显著高于NGT组和对照组(P<0.05),NGT组略高于对照组(P<0.05)。GDM组空腹血糖(fasting blood glucose, FBG)、空腹胰岛素(fasting insulin, FINS)、糖化血红蛋白(hemoglobin alc, HbA1c)、HOMA-IR、甘油三酯(triglyceride,TG)、LDL-C水平显著高于NGT组和对照组(P<0.05),HDL-C水平显著低于这两组(P<0.05),NGT组与对照组上述指标间差异无统计学意义(P>0.05)。GDM组血清Nesfatin-1、IL-6、hs-CRP、TNF-α、LP-PLA2水平均与HOMA-IR、TG呈高度正相关(r=0.606~0.791,P<0.05),与FBG、FINS、HbA1c、LDL-C均呈中低度正相关(r=0.243~0.406,P<0.05),与HDL-C呈中低度负相关(r=-0.294^-0.401,P<0.05),与总胆固醇无关(r=0.095~0.119,P>0.05)。受试者工作特征曲线(receiver operating characteristic curve,ROC)分析示血清hs-CRP、Nesfatin-1、LP-PLA2预测GDM的效能较高,AUC分别为0.978、0.895和0.878。由此孕早期监测血清Nesfatin-1、IL-6、hs-CRP、TNF-α、LP-PLA2水平可提高GDM检出率,有助于早期干预,改善母婴结局。

To investigate the early clinical predictive value of Nesfatin-1 and a variety of serum inflammatory factors in gestational diabetes mellitus(GDM), serum levels of Nesfatin-1, IL-6, hypersensitive C-reactive protein(hs-CRP), TNF-α and lipoprotein-associated phospholipase A2(LP-PLA2)were determined among 43 GDM patients, 51 pregnant women with normal glucose tolerance(NGT), and 40 healthy unpregnant women(control group). Serum levels of Nesfatin-1, IL-6, hs-CRP, TNF-α and LP-PLA2 were measured to explore the predictive value in GDM and the relationship with homeostasis model assessment insulin resistance(HOMA-IR) and glycolipid metabolism indexes. The results showed that the serum levels of Nesfatin-1, IL-6, hs-CRP, TNF-α, LP-PLA2 in GDM group were higher than those in NGT and control group(P<0.05), while those in NGT group were slightly higher than those in control group(P<0.05). The serum levels of FBG, fasting insulin(FINS), HbA1 c, HOMA-IR, triglyceride(TG) and LDL-C in GDM group were higher than those in NGT and control group(P<0.05), HDL-C was lower than those in NGT and control group(P<0.05), and there was no significant difference between NGT and control group(P>0.05). Serum Nesfatin-1, IL-6, hs-CRP, TNF-α and LP-PLA2 levels in GDM group were positively correlated with HOMA-IR and TG(r=0.606~0.791, P<0.05), and positively correlated with FBG, FINS, HbA1 c, LDL-C(r=0.243~0.406, P<0.05), and negatively correlated with HDL-C(r=-0.294^-0.401, P<0.05), but no significant correlation with total cholesterol(TC)(r=0.095~0.119, P>0.05). The results of ROC analysis showed that serum hs-CRP, Nesfatin-1 and LP-PLA2 were highly effective in predicting GDM, with AUC being 0.978, 0.895 and 0.878 respectively. Therefore, we concluded that early pregnancy monitoring of serum levels of Nesfatin-1, IL-6, hs-CRP, TNF-α and LP-PLA2 can increase the detection rate of GDM, which is helpful for early intervention and improvement of maternal and infant outcomes.