VCAM-1,TNF-α与妊娠期糖尿病患者血糖的关系及其对母婴结局的预测价值

The relationship between VCAM-1,TNF-α and blood glucose in patients with gestational diabetes and its predictive value for maternal and infant outcomes

目的分析血管内皮细胞粘附分子-1(VCAM-1)、肿瘤坏死因子-α(TNF-α)与妊娠期糖尿病(GDM)患者血糖的关系及其对母婴结局的预测价值。方法选择确诊的120例GDM患者为观察组,选择同期来院体检的正常孕妇80例为对照组。比较两组对象的VCAM-1、TNF-α、空腹血糖(FBG)、糖基化血红蛋白(HbA1c)水平及母婴结局,采用Pearson相关性分析VCAM-1,TNF-α与FBG,HbA1c的关系,采用多因素Logistic回归分析GDM患者母婴结局的影响因素,并采用受试者工作特征曲线(ROC)分析VCAM-1,TNF-α对母婴结局的预测价值。结果观察组VCAM-1,TNF-α,FBG,HbA1c水平均高于对照组,差异有统计学意义(P<0.05)。观察组患者的不良妊娠结局例数、不良新生儿结局例数明显多于对照组,差异有统计学意义(P<0.05)。Pearson相关性分析显示,VCAM-1,TNF-α均与FBG,HbA1c呈正相关(VCAM:r=0.476,0.484,TNF-α:r=0.451,0.472,P<0.01)。多因素Logistic回归分析显示,VCAM-1,TNF-α,FBG,HbA1c均为影响母婴结局的独立危险因素(P<0.05)。ROC曲线显示,VCAM-1,TNF-α预测GDM患者妊娠结局的AUC分别为0.753,0.750,而预测新生儿结局的AUC为0.710,0.707,具有一定预测价值。结论 VCAM-1,TNF-α与妊娠期糖尿病患者血糖呈正相关,联合检测血清VCAM-1,TNF-α水平可预测妊娠期糖尿病患者的母婴不良结局。

Objective To analyze the relationship between vascular endothelial cell adhesion molecule-1(VCAM-1),tumor necrosis factor-α(TNF-α) and blood glucose in patients with gestational diabetes(GDM) and their predictive value for maternal and infant outcomes.Methods One hundred and twenty confirmed GDM patients were selected as the observation group, and 80 normal pregnant women who came to the hospital for physical examination during the same period were selected as the control group.The levels of VCAM-1,TNF-α,fasting blood glucose(FBG),glycosylated hemoglobin(HbA1 c) and maternal and infant outcomes were compared between the two groups of subjects.Pearson correlation analysis was used to analyze the relationship between VCAM-1,TNF-α and FBG,HbA1 c.Multivariate Logistic regression was used to analyze the influencing factors of the maternal and infant outcome of GDM patients, and the receiver operating characteristic curve(ROC) was used to analyze the predictive value of VCAM-1 and TNF-α on the maternal and infant outcome.Results The levels of VCAM-1,TNF-α,FBG,and HbA1 c in the observation group were higher than those in the control group, and the difference was statistically significant(P<0.05).The number of adverse pregnancy outcomes and adverse neonatus outcomes in the observation group were significantly more than those in the control group, and the difference was statistically significant(P<0.05).Pearson correlation analysis showed that VCAM-1 and TNF-α were positively correlated with FBG and HbA1 c(VCAM:r=0.476,0.484,TNF-α:r=0.451,0.472,P<0.01).Multivariate logistic regression analysis showed that VCAM-1,TNF-α,FBG,and HbA1 c were all independent risk factors affecting the maternal and infant outcomes(P<0.05).The ROC curve shows that the AUC of VCAM-1 and TNF-α predicting pregnancy outcome of GDM patients are 0.753 and 0.750,respectively, while the AUC of predicting neonatal outcome is 0.710 and 0.707,which has certain predictive value.Conclusion VCAM-1 and TNF-α are positively correlated with blood glucose in patients with gestational diabetes.Combined detection of serum VCAM-1 and TNF-α levels can predict adverse maternal and infant outcomes in patients with gestational diabetes.