孕早期血清总胆红素、血尿酸水平联合超敏C反应蛋白对妊娠期糖尿病的预测价值

The Predictive Value of Serum Total Bilirubin,Serum Uric Acid and Hypersensitive C-reactive Rrotein for Gestational Diabetes Mellitus in Early Pregnanc

目的:探讨妊娠早期(8~12周)血清总胆红素水平、血尿酸水平及超敏C-反应蛋白水平对妊娠期糖尿病发病的预测价值。方法:收集2018年01月至2019年08月于石河子大学医学院第一附属医院定期门诊常规孕期检查孕妇400例。其中106例金标准诊断为妊娠期糖尿病患者作为实验组,294例正常妊娠妇女作为对照组,比较两组患者一般临床资料及孕早期(妊娠8~12周)TB、UA及hs-CRP水平的差异。采用二元Logistic回归探讨GDM的危险因素与孕早期血清TB、UA及hs-CRP水平之间的关系,并绘制ROC曲线分析其分别对GDM的预测价值及三个指标联合检测对GDM的预测价值。结果:对照组和实验组孕妇在年龄、孕前BMI、孕期增重、孕次、产次的差异无统计学意义,两组患者在TB、UA及hs-CRP比较有显著的统计学差异(P<0.05),且实验组上述三项值显著升高;二元Logistic回归分析提示孕早期TB、UA及hs-CRP是GDM的危险因素(P<0.05);ROC曲线分析提示TB、UA、hs-CRP及TB+UA+hs-CRP的曲线下面积分别是0.773、0.762、0.715、0.873;TB诊断GDM的灵敏度为75.5%、特异度为67.0%;UA诊断GDM的灵敏度为84%、特异度为60.5%;hs-CRP诊断GDM的灵敏度为62.3%、特异度为73.1%;TB+UA+hs-CRP联合检测的灵敏度为76.4%、特异度为89.1%。结论:TB、UA、hs-CRP是GDM的危险因素,与GDM的发病有相关性;孕早期TB、UA及hs-CRP联合检测对GDM的预测价值较其单独检测的预测价值明显升高;联合检测可更好地辅助临床医师对GDM早诊断、早干预、早治疗,减少GDM患者母婴一系列严重的并发症。

Objective:To study the Predictive value of serum total Bilirubin level,the blood Uric Acid level and High sensitivity C-reactive protein level in gestational diabetes mellitus in early stage of pregnancy(8 weeks to 12 weeks).Methods:From January 2018 to August 2019,400 pregnant women who received regular outpatient routine prenatal examinations at the first affiliated hospital of shihezi university school of medicine were collected.Among them,106 patients with gestational diabetes diagnosed as gold standard were treated as experimental group,and 294 normal pregnant women were treated as the control group.The general clinical data of the study subjects in the two groups and the differences in TB,UA and hs-crp levels in the early pregnancy(8~12 weeks)were compared.Binary Logistic regression was used to explore the relationship between risk factors of GDM and serum levels of TB,UA and hs-crp in early pregnancy,and ROC curve was drawn to analyze its predictive value for GDM and the predictive value of the three indexes combined detection for GDM.Results:There were no statistically significant differences between the control group and the experimental group in age,pre-pregnancy BMI,pregnancy weight gain,pregnancy number and birth number,but there were significant statistical differences between TB,UA and hs-crp groups(P<0.05),and the three values were significantly increased in the GDM group.Binary Logistic regression analysis suggested that TB,UA and hs-crp in early pregnancy were risk factors for GDM(P<0.05).ROC curve analysis indicated that the area under the curve of TB,UA,hs-crp and TB+UA+hs-crp was 0.773,0.762,0.715 and 0.873 respectively.The sensitivity and specificity of TB diagnosis of GDM were 75.5%and 67%respectively.The sensitivity and specificity of UA in diagnosing GDM were 84%and60.5%respectively.The sensitivity of hs-crp in diagnosing GDM was 62.3%and the specificity was 73.1%.The sensitivity of TB+UA+hs-crp combined detection was 76.4%and the specificity was 89.1%.Conclusion:TB,UA and hs-crp are risk factors for GDM,which are correlated with the incidence of GDM.The predictive value of TB,UA and hs-crp combined detection for GDM in early pregnancy was significantly higher than that of individual detection.Conclusions:Combined detection could improve the predictive value of GDM.It can better assist clinicians in early diagnosis,early intervention and early treatment of GDM,so as to reduce a series of serious complications of maternal and infant GDM patients as far as possible.