血清TTR、RBP4表达与妊娠期代谢综合征的相关性分析

Correlation analysis of serum TTR,RBP4 expressions and gestational metabolic syndrome

目的探讨血清转甲状腺素蛋白(transthyretin,TTR)、视黄醇结合蛋白4(retinol binding protein 4,RBP4)表达与妊娠期代谢综合征(gestational metabolic syndrome,GMS)的相关性。方法选取2017年5月至2019年12月烟台市烟台山医院收治的103例GMS患者为观察组,另外选取同期单胎妊娠、无并发症的健康妊娠孕妇100例为对照组。孕前进行身高、体质量指数(body mass index,BMI)检测,确诊GMS后,进行血清标志物及血压检测。采用日立7600全自动生化分析仪检测总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、空腹血糖(fasting blood glucose,FBG)水平,采用酶联免疫吸附法(ELISA)检测血清TTR、RBP4表达水平,并进行组间比较;绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估血清TTR、RBP4对GMS的诊断价值;采用多因素Logistic回归模型分析影响孕妇发生GMS的因素。结果对照组与观察组年龄、孕周相比,差异均无统计学意义(P>0.05);与对照组相比,观察组孕前BMI、TC、TG、LDL-C、FBG、收缩压、舒张压、血清TTR、RBP4表达水平均较高(P<0.05),HDL-C较低(P<0.05);血清TTR、RBP4单独及两者联合诊断GMS的曲线下面积(AUC)分别为0.797、0.816、0.898,TTR单独诊断的截断值为284.91 mg/L,敏感度、特异度分别为63.10%、89.00%,RBP4单独诊断的截断值为17.89 mg/L,敏感度、特异度分别为69.90%、87.00%,两者联合诊断的敏感度为83.50%,特异度为84.00%;多因素Logistic回归分析结果表明,TTR高水平、RBP4高水平均是影响孕妇发生GMS的独立危险因素(P<0.05)。结论GMS患者血清TTR、RBP4表达水平均较高,且对GMS具有一定诊断价值,是孕妇发生GMS的独立危险因素,可能为GMS的早期诊断及防治提供新思路。

Objective To investigate the relationship between the expressions of serum trans thyroxine protein(TTR),retinol binding protein 4(RBP4)and metabolic syndrome of pregnancy(GMS).Methods A total of 103 patients with GMS from May.2017 to Dec.2019 were selected as the observation group,in addition,100 healthy pregnant women with single pregnancy and no complications were selected as control group.Before pregnancy,the height and weight were detected.After the diagnosis of GMS,serum markers and blood pressure were detected.The levels of total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)and fasting blood glucose(FBG)were detected by Hitachi 7600 automatic biochemical analyzer,and the expression levels of TTR and RBP4 in serum were detected by enzyme-linked immunosorbent assay(ELISA).Receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of TTR and RBP4 in GMS.Multivariate Logistic regression model was used to analyze the influencing factors of GMS in pregnant women.Results There was no significant difference in age or gestational weeks between the two groups(P>0.05).Compared with those in the control group,the levels of BMI,TC,TG,LDL-C,FBG,systolic blood pressure,diastolic blood pressure,serum TTR and RBP4 expression levels were higher in the observation group before pregnancy(P<0.05),while HDL-C was lower(P<0.05).The area under the curve(AUC)of TTR and RBP4 alone or combination in the diagnosis of GMS was 0.797,0.816 and 0.898,respectively.The cut-off value of TTR was 284.91 mg/L,and the sensitivity and specificity were 63.10%and 89.00%,respectively.The cut-off value of RBP4 was 17.89 mg/L,and the sensitivity and specificity were 69.90%and 87.00%,respectively.The sensitivity and specificity of the combined diagnosis were 83.50%and 84.00%respectively.Multivariate Logistic regression analysis showed that high level of TTR and high level of RBP4 were independent risk factors of GMS in pregnant women(P<0.05).Conclusions The expression levels of serum TTR and RBP4 in GMS patients are high,and they have certain diagnostic value for GMS.They are independent risk factors of GMS in pregnant women,which may provide new ideas for the early diagnosis and prevention of GMS.