孕早期血清β-HCG、PAPP-A、ADP联合检测对妊娠期糖尿病的诊断价值

Diagnostic value of combined detection of serumβ-HCG,PAPP-A and ADP in early pregnancy on gestational diabetes mellitus

目的探讨孕早期血清β-人绒毛膜促性腺激素(β-HCG)、妊娠相关血浆蛋白A(PAPP-A)、脂联素(ADP)联合检测对妊娠期糖尿病(GDM)的诊断价值。方法选取2019年8月—2021年3月于广州市某医院就诊的134例GDM孕妇为研究对象,设为观察组。另选择同期于本院进行产前检查的140例健康孕妇为对照组。比较2组孕妇孕早期时(孕12周前)血清β-HCG、PAPP-A、ADP水平。采用Pearson相关系数分析β-HCG、PAPP-A、ADP水平与GDM孕妇孕24~28周空腹血糖(FBG)、糖化血红蛋白(HbA1c)等血糖指标水平检测结果的相关性。比较β-HCG、PAPP-A、ADP水平对GDM的单项诊断效能及联合诊断效能。采用多因素Logistic回归分析模型分析影响GDM发生的独立危险因素。结果观察组孕妇孕早期PAPP-A、ADP水平与孕24~28周时FBG、HbA1c水平均呈负相关关系(P<0.05);β-HCG与FBG、HbA1c则无相关性(P>0.05)。β-HCG、PAPP-A、ADP及3项联合检测诊断GDM的AUC分别为0.551、0.670、0.686、0.752,3项联合检测AUC大于单一指标诊断(P<0.05)。多因素Logistic回归分析结果显示:年龄≥35岁、孕前体质量指数(BMI)≥25 kg/m^(2)、产次≥1次、孕早期PAPP-A<1.37 MoM、孕早期ADP<9.80 mg/L均为GDM发生的独立危险因素(P<0.05)。结论相较于健康孕妇,GDM孕妇孕早期血清β-HCG水平无明显差异,而PAPP-A、ADP水平更低。PAPP-A、ADP水平是影响GDM发生的独立危险因素,临床应将β-HCG、PAPP-A、ADP联合检测应用于GDM诊断中,并对GDM高风险孕妇加强管理,改善孕妇妊娠结局。

Objective To investigate the diagnostic value of combined detection of serumβ-human chorionic gonadotropin(β-HCG),pregnancy-associated plasma protein A(PAPP-A),and adiponectin(ADP)in early pregnancy on gestational diabetes mellitus(GDM).Methods A total of 134 pregnant women with GDM who attended a hospital in Guangzhou from August 2019 to March 2021 were selected as subjects for the experimental group.Another 140 healthy pregnant women who underwent prenatal examination in this hospital during the same period were selected as the controls.The levels of serumβ-HCG,PAPP-A and ADP were compared between the two groups of pregnant women in early pregnancy.The correlation between the levels ofβ-HCG,PAPP-A and ADP and the levels of fasting blood glucose(FBG)and hemoglobin A1c(HbA1c)in pregnant women with GDM from 24 to 28 weeks of gestation was analyzed using the Pearson correlation coefficient.The single diagnostic efficacy and combined diagnostic efficacy ofβ-HCG,PAPP-A and ADP levels on GDM were compared.The independent risk factors for the occurrence of GDM were analyzed using the multivariate logistic regression analysis model.Results The levels of PAPP-A and ADP in early pregnancy in the experimental group were negatively correlated with the levels of FBG and HbA1c from 24 to 28 weeks of gestation(P<0.05);the levels ofβ-HCG was not correlated with those of FBG and HbA1c(P>0.05).The AUCs ofβ-HCG,PAPP-A,ADP and the three combined detection for the diagnosis of GDM were 0.551,0.670,0.686 and 0.752,respectively.The AUCs ofβ-HCG,PAPP-A,ADP and the combination of the three combined detection for the diagnosis of GDM were 0.551,0.670,0.686 and 0.752,respectively,and the AUCs of the three combined detection were greater than those of the single index diagnosis(P<0.05).Multivariate regression analysis showed that age≥35 years,pre-pregnancy BMI≥25 kg/m^(2),delivery≥1,PAPP-A<1.37 MoM in early pregnancy,and ADP<9.80 mg/L in early pregnancy were all independent risk factors for the development of GDM(P<0.05).Conclusion Compared with healthy pregnant women,there is no significant difference in serumβ-HCG levels in pregnant women with GDM in early pregnancy,who have lower PAPP-A and ADP levels.The levels of PAPP-A and ADP are independent risk factors for the occurrence of GDM.The combined detection ofβ-HCG,PAPP-A and ADP should be used in diagnosing GDM clinically,and the management of pregnant women with a high risk of GDM should be strengthened to improve the pregnancy outcomes.