妊娠糖尿病患者血清胎盘蛋白-13、分泌型卷曲相关蛋白5水平及其与妊娠结局的关系

Serum placental protein 13 and secreted frizzled-related protein 5 levels in patients with gestational diabetes mellitus and their relationship with pregnancy outcome

目的探讨妊娠糖尿病(gestational diabetes mellitus,GDM)患者血清胎盘蛋白-13(placental protein 13,PP-13)、分泌型卷曲相关蛋白5(secreted frizzled-related protein 5,SFRP5)水平及其与妊娠结局的关系。方法选取2018年1月至2019年12月中国人民解放军总医院第六医学中心接诊的GDM患者187例纳入研究组,选取同期正常产检的健康孕妇152例纳入对照组。比较两组孕妇血清PP-13、SFRP5水平及妊娠结局。根据妊娠结局将研究组孕妇分为妊娠结局不良组和妊娠结局良好组,分析PP-13、SFRP5对GDM孕妇妊娠结局的影响及其预测价值。结果研究组孕妇血清PP-13、SFRP5水平均显著低于对照组(均P<0.05),胎膜早破、产后出血、羊水异常、胎盘异常发生率均显著高于对照组(均P<0.05)。研究组54例(28.88%)孕妇妊娠结局不良。Logistic回归分析显示,稳态模型评估的胰岛素抵抗(homeostasis model assessment of insulin resistance,HOMA-IR)指数、空腹血糖均是GDM孕妇不良妊娠结局的独立危险因素(均P<0.05),PP-13、SFRP5均是独立保护因素(均P<0.05)。受试者操作特征曲线显示,PP-13、SFRP5、空腹血糖、HOMA-IR指数预测GDM孕妇不良妊娠结局的曲线下面积(area under the curve,AUC)分别为0.791、0.822、0.824、0.644;4项联合的AUC为0.958,灵敏度为88.9%,特异度为88.0%。结论GDM孕妇血清PP-13、SFRP5水平呈低表达,可能参与GDM的发生,且影响妊娠结局;空腹血糖、HOMA-IR指数、PP-13、SFRP5联合检测有助于预测GDM孕妇不良妊娠结局。

Objective To investigate the expression levels of serum placental protein 13(PP-13)and secreted frizzled-related protein 5(SFRP5)in patients with gestational diabetes mellitus(GDM)and their relationship with pregnancy outcomes.Method A total of 187 patients with GDM admitted to the Sixth Medical Center of PLA General Hospital from January 2018 to December 2019 were included in study group,and 152 healthy pregnant women who received normal antenatal check-ups were included in control group during the same period.The serum PP-13 and SFRP5 levels and pregnancy outcome were compared between the two groups of pregnant women.According to the pregnancy outcome,the pregnant women in study group were divided into poor pregnancy outcome group and good pregnancy outcome group.The influence of PP-13 and SFRP5 on the pregnancy outcome of GDM pregnant women and their predictive value were analyzed.Result Serum PP-13 and SFRP5 levels of pregnant women in study group were significantly lower than those in control group(all P<0.05),and premature rupture of membranes,postpartum hemorrhage,abnormal amniotic fluid,and placental abnormalities were significantly higher than those in control group(all P<0.05).The 54 cases(28.88%)of study group had poor pregnancy outcomes.Logistic regression analysis showed that homeostasis model assessment of insulin resistance(HOMA-IR)index and fasting blood glucose were independent risk factors for poor pregnancy outcome in pregnant women with GDM(all P<0.05),PP-13 and SFRP5 were independent protections factors(all P<0.05).The receiver operating characteristic curve showed that the area under the curve(AUC)of PP-13,SFRP5,fasting blood glucose,and HOMA-IR index predicting poor pregnancy outcomes of GDM pregnant women were 0.791,0.822,0.824,0.644,respectively.The AUC of the four combined items was 0.958,the sensitivity was 88.9%,and the specificity was 88.0%.Conclusion The levels of serum PP-13 and SFRP5 in pregnant women with GDM are lower,which may be involved in the occurrence of GDM and affect the outcome of pregnancy;the combined detection of fasting blood glucose,HOMA-IR index,PP-13,and SFRP5 can help predict adverse pregnancy outcomes in pregnant women with GDM.