血清VAP-1、PTX-3、PANDER在妊娠期糖尿病患者中的水平变化及其临床意义

Changes of serum VAP-1,PTX-3 and PANDER levels in patients with gestational diabetes mellitus and their clinical significance

目的探讨血清血管黏附蛋白-1(VAP-1)、正五聚蛋白-3(PTX-3)、胰腺衍生因子(PANDER)在妊娠期糖尿病(GDM)患者中的水平变化及其临床意义。方法选取2018年1月至2020年1月该院收治的GDM患者113例作为GDM组,另选取同期于该院产检的健康孕妇80例作为对照组。检测所有受试孕妇血清VAP-1、PTX-3、PANDER、空腹血糖(FBG)、空腹胰岛素(FINS)水平,计算胰岛素抵抗指数(HOMA-IR)。根据不良妊娠结局的发生情况,将GDM患者分为妊娠良好组(86例)和妊娠不良组(27例)。比较GDM组与对照组及不同妊娠结局GDM患者血清VAP-1、PTX-3、PANDER、FPG水平及HOMA-IR,分析血清VAP-1、PTX-3、PANDER水平与FBG、HOMA-IR的相关性,采用多因素Logistic回归模型分析影响GDM患者不良妊娠结局的危险因素,采用受试者工作特征(ROC)曲线分析血清VAP-1、PTX-3、PANDER对GDM患者不良妊娠结局的预测价值。结果GDM组血清VAP-1、PTX-3、PANDER、FPG水平及HOMA-IR高于对照组(P<0.05)。Pearson相关分析显示,血清VAP-1、PTX-3、PANDER水平与FPG、HOMA-IR均呈正相关(r>0.300,P<0.05)。妊娠良好组血清VAP-1、PTX-3、PANDER、FPG水平及HOMA-IR低于妊娠不良组(P<0.05)。多因素Logistic回归模型分析结果显示,血清VAP-1、PTX-3、PANDER水平升高是GDM患者不良妊娠结局的独立危险因素(P<0.05)。ROC曲线分析显示,血清VAP-1、PTX-3、PANDER联合检测预测GDM患者不良妊娠结局的曲线下面积为0.910(95%CI:0.881~0.972),灵敏度为0.705,特异度为0.896。结论GDM患者血清VAP-1、PTX-3、PANDER水平明显升高,这也是GDM患者不良妊娠结局的独立危险因素;联合检测血清VAP-1、PTX-3、PANDER对评估GDM患者不良妊娠结局有一定参考价值。

Objective To investigate the changes of serum vascular adhesion protein-1(VAP-1),pentraxin-3(PTX-3)and pancreatic derived factor(PANDER)in patients with gestational diabetes mellitus(GDM)and their clinical significance.Methods A total of 113 GDM patients admitted to this hospital from January 2018 to January 2020 were selected as the GDM group,and 80 healthy pregnant women during the same period of the hospital were selected as the control group.The serum levels of VAP-1,PTX-3,PANDER,fasting blood glucose(FBG)and fasting insulin(FINS)were detected,and the insulin resistance index(HOMA-IR)was calculated.According to the occurrence of adverse pregnancy outcomes,GDM patients were divided into the good pregnancy group(86 cases)and poor pregnancy group(27 cases).The serum levels of VAP-1,PTX-3,PANDER,FPG and HOMA-IR in the GDM group,control group and GDM patients with different pregnancy outcomes were compared.The correlation of the serum levels of VAP-1,PTX-3,PANDER with FBG and HOMA-IR was analyzed.Multivariate Logistic regression model was used to analyze the risk factors that affect the adverse pregnancy outcome of GDM patients.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum VAP-1,PTX-3 and PANDER in the adverse pregnancy outcome of GDM patients.Results The serum levels of VAP-1,PTX-3,PANDER,FPG and HOMA-IR in the GDM group were higher than those in the control group(P<0.05).Pearson correlation analysis showed that the serum levels of VAP-1,PTX-3 and PANDER were positively correlated with FPG and HOMA-IR(r>0.300,P<0.05).The serum levels of VAP-1,PTX-3,PANDER,FPG and HOMA-IR in the good pregnancy group were lower than those in the poor pregnancy group(P<0.05).Multivariate Logistic regression model analysis showed that the elevated serum levels of VAP-1,PTX-3 and PANDER were independent risk factors for adverse pregnancy outcomes in patients with GDM(P<0.05).The ROC curve analysis showed that the area under the curve for combined detection of serum VAP-1,PTX-3 and PANDER was 0.910(95%CI:0.881-0.972),the sensitivity was 0.705,and the specificity was 0.896.Conclusion The serum levels of VAP-1,PTX-3 and PANDER in patients with GDM increased significantly,which are independent risk factors for adverse pregnancy outcome in patients with GDM.The combined detection of serum VAP-1,PTX-3 and PANDER has a certain reference value in evaluating the adverse pregnancy outcomes in patients with GDM.