妊娠期糖尿病患者糖化白蛋白、内脂素、摄食抑制因子-1水平与胰岛素抵抗和妊娠结局的关系分析

Relationship Analysis between Glycated Albumin,Visfatin and Nesfatin-1 Level and Insulin Resistance and Pregnancy Outcome in Patients with Gestational Diabetes Mellitus

目的:观察妊娠期糖尿病(GDM)患者糖化白蛋白(GA)、内脂素(Visfatin)、摄食抑制因子-1(Nesfatin-1)水平与胰岛素抵抗的关系,并分析导致妊娠结局不良的危险因素。方法:选取2018年6月~2021年1月期间我院收治的120例GDM患者作为观察组,同一时间段选择来我院行孕检的90例正常孕妇作为对照组。检测受试者血清中Visfatin、Nesfatin-1、GA、空腹胰岛素(FINS)、空腹血糖(FPG)水平,计算胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)。采用Pearson相关分析Visfatin、Nesfatin-1、GA与胰岛素抵抗的关系。采用多因素Logistic回归分析妊娠结局不良的影响因素。结果:观察组的GA、Visfatin、Nesfatin-1、HOMA-IR高于对照组,HOMA-β低于对照组(P<0.05)。Pearson相关分析结果显示,GA、Visfatin、Nesfatin-1与HOMA-β呈负相关,而与HOMA-IR呈正相关(P<0.05)。观察组的妊娠不良结局发生率明显高于对照组(P<0.05)。单因素分析结果显示:妊娠不良结局与分娩年龄、居住地、糖尿病家族史、产前体质量指数(BMI)、合并多囊卵巢综合征、流产史、分娩史、甲状腺功能情况、产次、FPG、FINS、GA、Visfatin、Nesfatin-1、HOMA-IR、HOMA-β有关(P<0.05),而与文化程度、单/双胎妊娠、孕次无关(P>0.05)。Logistic回归分析结果显示:居住地为城市、产前BMI≥28 kg/m^(2)、分娩年龄≥35岁、合并多囊卵巢综合征、GA≥13%、Visfatin≥82mmol/L、Nesfatin-1≥9μg/L、流产史、甲状腺功能异常是导致GDM产妇妊娠结局不良的危险因素(P<0.05)。结论:GDM患者中存在GA、Visfatin、Nesfatin-1高表达,且与胰岛素抵抗明显相关。GDM产妇的妊娠不良结局发生率较高,受分娩年龄、居住地、产前BMI、合并多囊卵巢综合征、流产史、GA、Visfatin、Nesfatin-1、甲状腺功能异常等多种因素影响,可考虑针对上述患者采取相关干预措施,以改善患者的妊娠结局。

Objective: To observe the relationship between glycated albumin(GA), Visfatin(Visfatin) and Nesfatin--1(Nesfatin-1)levels and insulin resistance in patients with gestational diabetes mellitus(GDM), and to analyze the risk factors leading to poor pregnancy outcome. Methods: 120 patients with GDM who were treated in our hospital from June 2018 to January 2021 were selected as the observation group. Another 90 normal pregnant women who underwent physical examination in our hospital in the same period were selected as the control group. The levels of Visfatin, Nesfatin-1, GA, fasting insulin(FINS) and fasting blood glucose(FPG) were measured, Insulin resistance index(HOMA-IR) and islet β cell function index(HOMA-β) were calculated. Pearson correlation analysis was used to analyze the relationship between Visfatin, Nesfatin-1 and GA and insulin resistance. Multivariate Logistic regression was used to analyze the influencing factors of poor pregnancy outcome. Results: GA, Visfatin, Nesfatin-1 and HOMA-IR in the observation group were higher than those in the control group, HOMA-β was lower than that in the control group(P<0.05). Pearson correlation analysis showed that GA,Visfatin and Nesfatin-1 were negatively correlated with HOMA-β, but positively correlated with HOMA-IR(P<0.05). The incidence of poor pregnancy outcome in the observation group was significantly higher than that in the control group(P<0.05). Univariate analysis showed that the adverse outcomes of pregnancy were related to childbirth age, residence, family history of diabetes, prenatal body mass index(BMI), polycystic ovary syndrome, history of abortion, delivery history, thyroid function, parity, FPG, FINS, GA, Visfatin, Nesfatin-1, HOMA-IR and HOMA-β(P<0.05), but it was not related to educational level, single or twin pregnancy and pregnancy times(P>0.05). Logistic regression analysis showed that residence in city, prenatal BMI ≥28 kg/m^(2), delivery age ≥35 years old, polycystic ovary syndrome,GA≥13%, Visfatin≥82 mmol/L, Nesfatin-1≥9 μg/L, abortion history and abnormal thyroid function were the risk factors for poor pregnancy outcome of GDM pregnant women(P<0.05). Conclusion: There are high expression of GA, Visfatin and Nesfatin-1 in patients with GDM, which are significantly related to insulin resistance. The incidence of adverse pregnancy outcomes of GDM pregnant women is high. It is affected by many factors, such as delivery age, place of residence, prenatal BMI, polycystic ovary syndrome, abortion history, GA, Visfatin, Nesfatin-1, abnormal thyroid function and so on. It can be considered to take relevant intervention measures for the above patients to improve their pregnancy outcomes.