孕中期孕妇血清AFP、free-βHCG、uE3与GDM的关系

Relationship between AFP,free-βHCG,uE3 and GDM in the second trimester of pregnancy

目的探讨孕中期血清甲胎蛋白(AFP)、游离绒毛膜促性腺激素β亚单位(free-βHCG)、游离雌三醇(uE3)与妊娠糖尿病(GDM)的关系。方法选取行孕中期唐氏血清学筛查且住院分娩的孕妇17005例,根据是否患GDM分为GDM组(378例)和正常妊娠组(16627例),采用微粒子免疫化学发光法检测所有孕妇的血清AFP、free-βHCG、uE3,并计算各指标的中位数倍数(MoM)。采用多因素Logistic回归分析评估GDM的影响因素。采用受试者工作特征(ROC)曲线评估AFP MoM、free-βHCG MoM、uE3 MoM对GDM的诊断价值。结果GDM组年龄、体质量指数(BMI)、空腹血糖(FBG)、AFP MoM、free-βHCG MoM水平和餐后1 h血糖、2 h血糖高于正常妊娠组(P<0.05),uE3 MoM水平低于正常妊娠组(P<0.05);孕周、收缩压、舒张压、血脂水平2个组之间差异均无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,年龄、BMI、FBG、AFP MoM、free-βHCG MoM和餐后1 h血糖、2 h血糖是GDM发生的独立危险因素[比值比(OR)值分别为1.093、1.107、1.359、1.254、1.242和1.587、1.520,95%可信区间(CI)分别为1.021~1.135、1.058~1.249、1.167~1.560、1.103~1.458和1.076~1.412和1.224~1.813、1.372~1.796],uE3 MoM是GDM发生的独立保护因素(OR=0.901,95%CI为0.864~0.956)。ROC曲线分析结果显示,AFP MoM、free-βHCG MoM、uE3 MoM及三者联合检测诊断GDM的曲线下面积(AUC)分别为0.904、0.852、0.854、0.931。结论孕中期血清AFP、free-βHCG、uE3的异常改变对GDM诊断有一定的价值,可辅助临床评估GDM的发生风险。

Objective To investigate the relationship between serum alpha fetoprotein(AFP),free beta human chorionic gonadotrophin(free-βHCG),unconjugated estriol(uE3)and gestational diabetes mellitus(GDM)in the second trimester of pregnancy.Methods A total of 17005 pregnant women who underwent Down's screening in the second trimester of pregnancy and delivered were enrolled,and they were classified into GDM patients(GDM group,378 cases)and healthy pregnant women(control group,16627 cases).Serum AFP,free-βHCG and uE3 were determined by time-resolved fluorescence immunoassay.The multiple of median(MoM)of each index was calculated.Multivariate Logistic regression analysis was used to analyze the influencing factors of GDM,and receptor operating characteristic(ROC)curve was drawn to evaluate the diagnostic values of AFP MoM,free-βHCG MoM and uE3 MoM for GDM.Results The age,body mass index(BMI),fasting blood glucose(FBG),postprandial 1 h blood glucose,postprandial 2 h blood glucose,AFP MoM,free-βHCG MoM in GDM group were higher than those in control group(P<0.05),and the uE3 MoM was lower than that in control group(P<0.05).Gestational week,systolic blood pressure,diastolic blood pressure and blood lipid in the 2 groups had no statistical significance(P>0.05).Age,BMI,FBG,postprandial 1 h blood glucose,postprandial 2 h blood glucose,AFP MoM and free-βHCG MoM were independent risk factors of GDM[odds ratios(OR)were 1.093,1.107,1.359,1.587,1.520,1.254,1.242,95%confidence interval(CI)were 1.021-1.135,1.058-1.249,1.167-1.560,1.224-1.813,1.372-1.796,1.103-1.458,1.076-1.412],and uE3 MoM was an independent protective factor for GDM(OR=0.901,95%CI 0.864-0.956).The areas under curves(AUC)of AFP MoM,free-βHCG MoM,uE3 MoM and the combined determination for diagnosing GDM were 0.904,0.852,0.854 and 0.931,respectively.Conclusions AFP,free-βHCG and uE3 play roles in the diagnosis of GDM,which can predict GDM.