孕早期肠道菌群检测对妊娠期糖尿病的预测及评估价值

Prediction and evaluation value of intestinal flora detection in early pregnancy for gestational diabetes mellitus

目的研究孕早期肠道菌群检测对妊娠期糖尿病(GDM)的预测及评估价值。方法选择2018年3月至2021年8月期间在河南省安阳市妇幼保健院建卡并规律产检的342例孕妇作为研究对象,根据孕中期口服葡萄糖耐量试验(OGTT)结果将其分为GDM组(n=32)和对照组(n=310)。孕早期检测肠道菌群多样性指标Ace指数、OTUs、Chao 1指数、Shannon指数、Simpson指数及厚壁菌门、拟杆菌门、变形菌门、放线菌门、瘤胃菌门的丰富度,孕中期计算胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能指数(HOMA-β)。结果对照组比较,GDM组孕早期粪便中肠道菌群的Ace指数、OTUs、Chao 1指数及拟杆菌门、变形菌门的丰富度增加,差异有统计学意义(P<0.05),厚壁菌门、放线菌门的丰富度均明显降低,差异有统计学意义(P<0.05);经ROC曲线分析,孕早期粪便中肠道菌群多样性指标Ace指数、OTUs、Chao 1指数、拟杆菌门、变形菌门、厚壁菌门、放线菌门丰富度均对GDM具有预测价值(P<0.05);经Pearson检验,GDM组孕早期粪便中肠道菌群多样性指标Ace指数、OTUs、Chao 1指数及拟杆菌门、变形菌门丰富度与HOMA-IR呈正相关,与HOMA-β呈负相关,厚壁菌门、放线菌门丰富度与HOMA-IR呈负相关,与HOMA-β呈正相关。结论孕早期肠道菌群多样性及丰富度的变化与GDM的发病有关,能够预测GDM并评估GDM的胰岛素抵抗程度。

Objective To study the prediction and evaluation value of intestinal flora detection in early pregnancy for gestational diabetes mellitus(GDM). Methods 342 pregnant women who established cards in our hospital and received regular prenatal examination from March 2018 to August 2021 were selected as the research objects. They were divided into the GDM group(n=32)and the control group(n=310)according to the results of oral glucose tolerance test(OGTT)in the second trimester of pregnancy. The indexes of intestinal flora diversity Ace index,OTUs,Chao 1 index,Shannon index,Simpson index and the richness of firmicutes,bacteroidetes,proteus,actinomycetes and rumen bacteria were detected in the early pregnancy.The insulin resistance index(HOMA-IR) and islet β cell function index(HOMA-β) were calculated.Results Compared with the control group,the Ace index,OTUs index,Chao 1 index and the richness of bacteroidetes and proteus significantly increased(P<0.05),the richness of firmicutes and actinomycetes in the feces in the GDM group significantly decreased(P<0.05),and the Shannon index,Simpson index and the richness of rumen bacteria did not change significantly(P>0.05). ROC curve analysis showed that Ace index,OTUs,Chao1 index,richness of bacteroidetes,proteus,firmicutes and actinomycetes in feces in early pregnancy had predictive value for GDM(P<0.05). Pearson analysis showed that Ace index,OTUs index,Chao 1 index,bacteroidetes and proteus richness was positively correlated with HOMA-IR and negatively correlated with HOMA-β,firmicutes and actinomycetes richness in feces in the GDM group were negatively correlated with HOMA-IR and positively correlated with HOMA-β. Conclusion Changes in the diversity and abundance of gut microbiota in early pregnancy are associated with the onset of GDM,and can predict GDM and assess the degree of insulin resistance in GDM.