血清丝氨酸蛋白酶抑制剂B1在妊娠期糖尿病诊断及妊娠结局评估中的价值

Values of serum serine protease inhibitor B1 in diagnosis of gestational diabetes mellitus and in evaluation of pregnancy outcome

目的探讨血清丝氨酸蛋白酶抑制剂B1(SerpinB1)在妊娠期糖尿病(GDM)诊断及妊娠结局评估中的价值。方法回顾性分析264例孕妇的临床资料,将诊断为GDM的83例孕妇作为观察组,181例正常孕妇为对照组,比较两组SerpinB1、空腹血糖、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)水平及稳态模型胰岛素抵抗(HOMA-IR)指数,并分析观察组SerpinB1水平与空腹血糖、HbA1c、FINS水平及HOMA-IR指数的相关性。采用受试者工作特征(ROC)曲线分析SerpinB1水平诊断GDM的价值。将观察组根据妊娠结局进一步分为不良结局组(16例)及正常结局组(67例),比较两组SerpinB1水平,并采用ROC曲线分析SerpinB1水平评估GDM孕妇妊娠结局的价值。结果观察组SerpinB1、空腹血糖、HbA1c、FINS水平及HOMA-IR指数均高于对照组(均P<0.05),且观察组SerpinB1水平与空腹血糖、FINS水平及HOMA-IR指数均呈正相关(均P<0.05)。不良结局组SerpinB1水平高于正常结局组(P<0.05)。当SerpinB1截断值为2.712 ng/mL时,其诊断GDM的曲线下面积为0.883(P<0.05)。当SerpinB1截断值为3.516 ng/mL时,其预测GDM孕妇不良妊娠结局的曲线下面积为0.813(P<0.05)。结论GDM孕妇血清SerpinB1水平上升,与胰岛素抵抗存在一定的关系,SerpinB1水平在GDM诊断及不良妊娠结局评估中均具有一定的临床价值。

Objective To explore the values of serum serine protease inhibitor B1(SerpinB1)for diagnosing gestational diabetes mellitus(GDM)and for evaluating pregnancy outcome.Methods The clinical data of 264 pregnant women were retrospectively analyzed,among whom 83 cases diagnosed with GDM were assigned to observation group.And 181 normal pregnant women were assigned to control group.The levels of SerpinB1,fasting blood glucose,glycosylated hemoglobin(HbA1c),and fasting insulin(FINS),as well as homeostasis model assessment-insulin resistance(HOMA-IR)index were compared between the two groups;furthermore,the correlations of SerpinB1 level with the levels of fasting blood glucose,HbA1c,FINS,and HOMA-IR index in the observation group were analyzed.The receiver operating characteristic(ROC)curve was used to analyze the value of SerpinB1 level for diagnosing GDM.The observation group was further assigned to adverse outcome group(16 cases)or normal outcome group(67 cases)according to the pregnancy outcome.SerpinB1 level was compared between the two groups,and the ROC curve was employed to analyze the value of SerpinB1 level for evaluating pregnancy outcome in pregnant GDM women.Results The observation group yielded higher levels of SerpinB1,fasting blood glucose,HbA1c,and FINS,and an increased HOMA-IR index as compared with the control group(all P<0.05),and SerpinB1 level positively correlated with the levels of fasting blood glucose and FINS,and HOMA-IR index in the observation group(all P<0.05).The adverse outcome group expressed a higher level of SerpinB1 compared to the normal outcome group(P<0.05).The area under the curve of SerpinB1 level for diagnosing GDM was 0.883 when its cut-off value was 2.712 ng/mL(P<0.05).The area under the curve of SerpinB1 level for predicting adverse pregnancy outcome of pregnant GDM women was 0.813 when its cut-off value was 3.516 ng/mL(P<0.05).Conclusion Serum SerpinB1 level is increased in pregnant GDM women,which is associated with insulin resistance.SerpinB1 level has clinical values for diagnosing GDM and for evaluating adverse pregnancy outcome in a certain extent.