孕早期血清沉默信息调节因子2相关酶1水平预测孕妇发生妊娠期糖尿病的价值

Predictive value of serum silencing information regulator 2 related enzyme 1 level in early pregnancy for pregnant women suffering from gestational diabetes mellitus

目的探讨孕早期血清沉默信息调节因子2相关酶1(SIRT1)水平预测孕妇发生妊娠期糖尿病(GDM)的价值。方法纳入270例孕妇,根据孕24~28周时OGTT结果,将符合GDM诊断标准的孕妇纳入GDM组(n=42),将糖代谢正常的孕妇纳入对照组(n=228)。比较两组孕妇孕8~12周时的一般资料及实验室指标水平。采用Logistic回归模型分析孕妇发生GDM的影响因素,采用受试者工作特征(ROC)曲线分析孕早期血清SIRT1水平预测孕妇发生GDM的价值。比较孕早期不同血清SIRT1水平GDM孕妇的孕中期OGTT结果。结果GDM组孕妇的年龄、孕前体质指数,孕早期白细胞计数、血红蛋白水平、空腹血糖水平,以及有糖尿病家族史的孕妇比例大于或高于对照组,孕早期血清SIRT1水平低于对照组(均P<0.05)。Logistic回归模型分析结果显示,孕前体质指数、糖尿病家族史,以及孕早期血红蛋白水平、空腹血糖水平及血清SIRT1水平是孕妇发生GDM的影响因素(均P<0.05)。ROC曲线结果显示,孕早期血清SIRT1水平预测孕妇发生GDM的曲线下面积为0.917,取最佳截断值为5.68 ng/mL时,其预测孕妇发生GDM的灵敏度和特异度分别为85.09%、78.57%。孕早期高血清SIRT1水平的孕妇孕中期空腹血糖、服糖后1 h血糖、服糖后2 h血糖、空腹血胰岛素、服糖后1 h血胰岛素、服糖后2 h血胰岛素水平均低于低血清SIRT1水平的孕妇(均P<0.05)。结论GDM孕妇孕早期血清SIRT1水平降低。孕早期血清SIRT1水平是孕妇发生GDM的影响因素,其对GDM具有较高的预测价值。

Objective To explore the predictive value of serum silencing information regulator 2 related enzyme 1(SIRT1)in early pregnancy for pregnant women suffering from gestational diabetes mellitus(GDM).Methods A total of 270 pregnant women were enrolled,according to OGTT results at 24-28 weeks of pregnancy,the pregnant women who met the GDM diagnostic criteria were divided into GDM group(n=42),and those with normal glucose metabolism into control group(n=228).The general data,laboratory index levels were compared between the pregnant women of the two groups at 8-12 weeks of pregnancy.The influencing factors for pregnant women suffering from GDM were analyzed by the Logistic regression model.The value of serum SIRT1 level in early pregnancy for predicting pregnant women suffering from GDM was analyzed by the receiver operating characteristic(ROC)curve.The OGTT results in the second trimester of pregnancy were compared between the GDM pregnant women with different serum SIRT1 levels in early pregnancy.Results The age and pre-pregnancy body mass index of pregnant women,and white blood cell count,hemoglobin and fasting blood glucose levels of pregnant women in early pregnancy,as well as the proportion of pregnant women with family history of diabetes mellitus in the GDM group were all larger or higher than those in the control group,and the serum SIRT1 level in early pregnancy in the GDM group was lower than that in the control group(all P<0.05).The results of Logistic regression model analysis revealed that pre-pregnancy body mass index,family history of diabetes mellitus,and hemoglobin,fasting blood glucose and serum SIRT1 levels in early pregnancy were the influencing factors for pregnant women suffering from GDM(all P<0.05).The ROC curve results interpreted that the area under the curve of serum SIRT1 level in early pregnancy for predicting pregnant women suffering from GDM was 0.917,when the optimal cutoff value of 5.68 ng/mL was acquired,its sensitivity and specificity for predicting pregnant women suffering from GDM were 85.09%and 78.57%,respectively.The pregnant women with high serum SIRT1 level in early pregnancy exhibited lower levels of fasting blood glucose,blood glucose 1 hour after administration of sugar,blood glucose 2 hours after administration of sugar,fasting blood insulin,blood insulin 1 hour after administration of sugar,and blood insulin 2 hours after administration of sugar in the second trimester of pregnancy as compared with the pregnant women with low serum SIRT1 level(all P<0.05).Conclusion The serum SIRT1 level in early pregnancy is decreased in GDM pregnant women.Serum SIRT1 level in early pregnancy is the influencing factor for pregnant women suffering from GDM,exerting a relatively high predictive value on GDM.