妊娠期糖尿病患者血清Metrnl、FABP4水平变化及临床意义

Changes of serum Metrnl and FABP4 levels in patients with gestational diabetes mellitus and their clinical significance

目的探讨血清Metrnl、脂肪酸结合蛋白4(fatty acid binding protein 4,FABP4)在妊娠期糖尿病(gestational diabetes mellitus,GDM)患者血清中的水平变化及临床意义。方法选取2020年12月至2021年9月于济南市第八人民医院就诊的孕24~28周孕妇72例,根据口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)结果分为GDM组38例、正常糖耐量(normal glucose tolerance,NGT)组34例。测定两组血糖、血脂、超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、肿瘤坏死因子α(tumor necrosis factorα,TNF-α)、白介素6(interleukin 6,IL-6)、Metrnl、FABP4水平。Pearson相关分析血清Metrnl与其他临床指标水平的相关性,多因素Logistic回归分析发生GDM的影响因素,受试者工作特征(receiver operating characteristic,ROC)曲线分析血清Metrnl、FABP4水平对GDM的诊断效能。结果GDM组血清Metrnl水平低于NGT组,TNF-α、IL-6、FABP4水平高于NGT组,差异均有统计学意义(P<0.05)。Pearson相关分析显示,Metrnl与甘油三酯(triglyceride,TG)、糖化血红蛋白(glycosylated hemoglobin HbA1c)、胰岛素抵抗指数(homeostasis model asessment insulin resistance,HOMA-IR)、TNF-α、IL-6、FABP4呈负相关(P<0.05)。Logistic回归分析显示,Metrnl、FABP4为发生GDM的影响因素。ROC分析显示,血清Metrnl诊断GDM的ROC曲线下面积为0.798;FABP4诊断GDM的ROC曲线下面积为0.711;两者联合诊断GDM的ROC曲线下面积为0.860,灵敏度、特异度均高于各指标单独诊断。结论血清Metrnl在GDM中表达降低,FABP4在GDM中表达升高,两者呈负相关,可能通过糖脂代谢、胰岛素抵抗、炎症反应机制,共同参与了GDM的发生,两者联合有望成为诊断GDM新的血清学标志物。

Objective To investigate the changes of serum Metrnl and fatty acid binding protein 4(FABP4)in serum of patients with gestational diabetes mellitus(GDM)and their clinical significance.Methods A total of 72 pregnant women at 24 to 28 weeks gestation were selected from the Eighth People’s Hospital of Jinan from December 2020 to September 2021.According to the results of oral glucose tolerance test(OGTT),patients were divided into GDM group(38 cases)and normal glucose tolerance(NGT)group(34 cases).Blood glucose,blood lipid,high sensitivity C-reactive protein(hs-CRP),tumor necrosis factorα(TNF-α),interleukin 6(IL-6),Metrnl,FABP4 levels in the two groups were measured.Pearson correlation was used to analyze the correlation between serum Metrnl and other clinical indicators,and multiple Logistic regression was used to analyze the influencing factors of GDM.The diagnostic efficacy of serum Metrnl and FABP4 levels for GDM was analyzed by receiver operating characteristic(ROC)curve.Results The serum Metrnl level in GDM group was lower than that in NGT group,and the levels of TNF-α,IL-6 and FABP4 were higher than those in NGT group,with statistical significances(P<0.05).Pearson correlation analysis showed that Metrnl and triglyceride(TG),glycosylated hemoglobin(HbA1c),and homeostasis model asessment insulin resistance(HOMA-IR),TNF-α,IL-6 and FABP4 were negatively correlated(P<0.05).Logistic regression analysis showed that Metrnl and FABP4 were the factors affecting the occurrence of GDM.ROC analysis showed that the area under ROC curve of GDM diagnosed by Metrnl serum was 0.798.The area under ROC curve of FABP4 for diagnosing GDM was 0.711.The area under ROC curve of the combined diagnosis of GDM was 0.860,and the sensitivity and specificity were higher than those of the single diagnosis of each index.Conclusion The expression of Metrnl decreased in GDM,while FABP4 increased in GDM,showing a negative correlation between the two,which may be involved in the occurrence of GDM through glucolipid metabolism,insulin resistance and inflammation.The combination of the two is expected to be a new serological marker for the diagnosis of GDM.