血清同型半胱氨酸、胰腺衍生因子、肥胖抑制素与妊娠期糖尿病患者血糖控制情况和妊娠结局的关系分析

Relationship Analysis between Serum Homocysteine,PANDER,Obestatin and Blood Glucose Control Situation and Pregnancy Outcome in Patients with Gestational Diabetes Mellitus

目的:探讨血清同型半胱氨酸(Hcy)、胰腺衍生因子(PANDER)、肥胖抑制素(Obestatin)与妊娠期糖尿病(GDM)患者血糖控制情况和妊娠结局的关系。方法:选择2021年1月至2022年1月于我院就诊的286例GDM患者,根据分娩前糖化血红蛋白(Hb A1c)水平分为血糖控制达标组(HbA1c<7%,173例)和血糖控制不达标组(HbA1c≥7%,113例),检测并比较两组患者入组时血清Hcy、PANDER、Obestatin、空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗(HOMA-IR)水平,采用Pearson相关分析Hcy、PANDER、Obestatin与FPG、FINS、HOMA-IR的相关性。根据妊娠结局分为妊娠结局不良组(90例)和妊娠结局良好组(196例),采用多因素Logistic回归分析GDM患者妊娠结局的影响因素。结果:血糖控制不达标组血清Hcy、PANDER、FPG、FINS、HOMA-IR水平均高于血糖控制达标组,而Obestatin水平低于血糖控制达标组(P<0.05)。血清Hcy、PANDER水平与FPG、FINS、HOMA-IR水平均呈正相关,Obestatin水平与FPG、FINS、HOMA-IR水平均呈负相关(P<0.05)。妊娠结局不良组年龄、入组时体质量指数(BMI)、糖尿病家族史、血糖控制不达标比例以及血清Hcy、PANDER、FPG、FINS、HOMA-IR水平均高于妊娠结局良好组,Obestatin水平则低于妊娠结局良好组(P<0.05)。血糖控制不达标、血清Hcy、PANDER水平是GDM患者妊娠结局不良的危险因素,而Obestatin水平是保护因素(P<0.05)。结论:GDM血糖控制不达标患者血清Hcy、PANDER水平增高,Obestatin水平降低,且与胰岛素抵抗和妊娠结局不良有关。

Objective:To investigate the relationship between serum homocysteine(Hcy),PANDER,Obestatin and blood glucose control situation and pregnancy outcome in patients with gestational diabetes mellitus(GDM).Methods:286 patients with GDM who were treated in our hospital from January 2021 to January 2022 were selected.According to the level of glycosylated hemoglobin(HbA1c)before delivery,they were divided into blood glucose control standard group(HbA1c<7%,173 cases)and blood glucose control non standard group(HbA1c≥7%,113 cases).The levels of serum Hcy,PANDER,Obestatin,fasting plasma glucose(FPG),fasting insulin(FINS)and insulin resistance(HOMA-IR)at the time of enrollment in the two groups of patients were detected and compared.Pearson correlation analysis was used to analyze the correlation between Hcy,PANDER,Obestatin and FPG,FINS and HOMA-IR.According to the pregnancy outcome,they were divided into poor pregnancy outcome group(90 cases)and good pregnancy outcome group(196 cases).Multivariate Logistic regression was used to analyze the influencing factors of pregnancy outcome in patients with GDM.Results:The levels of serum Hcy,PANDER,FPG,FINS and HOMA-IR in the blood glucose non control standard group were higher than those in the blood glucose control standard group,while the level of Obestatin was lower than those in the blood glucose control standard group(P<0.05).The levels of serum Hcy and PANDER were positively correlated with the levels of FPG,FINS and HOMA-IR,and the level of Obestatin were negatively correlated with the levels of FPG,FINS and HOMA-IR(P<0.05).The age,body mass index(BMI)at enrollment,family history of diabetes,proportion of blood glucose control not up to standard and the levels of serum Hcy,PANDER,FPG,FINS and HOMA-IR in the poor pregnancy outcome group were higher than those in the good pregnancy outcome group,while the level of Obestatin was lower than that in the good pregnancy outcome group(P<0.05).Blood glucose control not up to standard,the levels of serum Hcy and PANDER were the risk factors of poor pregnancy outcome in patients with GDM,while the level of Obestatin was the protective factor(P<0.05).Conclusion:The levels of serum Hcy and PANDER increased and the level of Obestatin decreased in patients with blood glucose control not up to standard in GDM,which are related to insulin resistance and poor pregnancy outcome.