妊娠早期血清色氨酸和脯氨酸表达水平检测对妊娠期糖尿病的预测价值研究

Study on the Predictive Value of Serum Tryptophan and Proline Expression Levels in Early Pregnancy for Gestational Diabetes Mellitus

目的探讨妊娠早期血清色氨酸和脯氨酸表达水平检测对妊娠期糖尿病(gestational diabetes mellitus,GDM)的预测价值研究。方法选择2020年8月~2021年1月在枣庄市妇幼保健院产检的孕7~13周单胎初产妇90例,留取空腹外周静脉血,根据孕中期口服75g葡萄糖耐量试验(oral glucose tolerance test,OGTT)结果分为GDM孕妇(观察组)28例和糖耐量正常孕妇(对照组)62例。采用液相色谱-串联质谱(liquid chromatography-tandem mass spectrometry,LC-MS/MS)方法检测妊娠早期血清色氨酸、脯氨酸表达水平,分析GDM孕妇妊娠早期血清色氨酸、脯氨酸表达水平与孕中期糖代谢指标的相关性,采用Logistic回归分析GDM发生的独立影响因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析妊娠早期色氨酸、脯氨酸水平检测对GDM的预测价值。结果与对照组比较,观察组妊娠早期血清色氨酸(1.85±0.31μg/ml vs 2.14±0.28μg/ml)、脯氨酸(19.98±4.36μg/ml vs 25.23±5.00μg/ml)水平降低,差异均有统计学意义(t=-3.31,-3.90,均P<0.01);与对照组比较,观察组孕中期FBG(5.07±0.68 mmol/L vs 4.75±0.35 mmol/L),HbA1c(5.29%±0.22%vs 5.13%±0.29%),FINS(19.29±3.81μU/ml vs 12.52±2.59μU/ml)及HOMA-IR(2.63±0.19 vs 1.54±0.18)水平升高,差异均有统计学意义(t=2.23~18.44,均P<0.05)。Pearson相关性分析显示GDM孕妇妊娠早期血清色氨酸、脯氨酸水平与妊娠中期FBG,HbA1c,FINS和HOMA-IR呈负相关(r色氨酸=-0.26,-0.24,-0.37,-0.45;r脯氨酸=-0.33,-0.47,-0.41,-0.49,均P<0.05),妊娠早期血清色氨酸水平与脯氨酸水平呈正相关(r=0.455,P<0.05)。Logistic回归分析显示血清色氨酸(OR=-0.355,95%CI:-0.456~-0.033),脯氨酸(OR=-0.393,95%CI:-7.956~-1.039)是GDM发生的保护因素(P<0.05)。ROC曲线分析显示:妊娠早期血清色氨酸、脯氨酸水平检测预测GDM的曲线下面积(AUC)为0.750(95%CI:0.599~0.901)和0.794(95%CI:0.651~0.937),分别以2.12μg/ml和23.22μg/ml为最佳阈值,敏感度为55%和70%,特异度为80%和85%。两者联合检测预测GDM的AUC为0.825(95%CI:0.694~0.956),敏感度和特异度分别为70%和85%。结论GDM孕妇妊娠早期血清色氨酸和脯氨酸表达水平降低,妊娠早期血清色氨酸和脯氨酸表达水平检测对GDM具有一定预测价值。

Objective To investigate the predictive value of serum tryptophan and proline expression levels in early pregnancy for gestational diabetes mellitus(GDM).Methods A total of 90 singleton parturients at 7 to 13 weeks of gestation were selected from August 2020 to January 2021 in Maternal and Child Health Care Hospital of Zaozhuang.Fasting peripheral venous blood was collected,According to the results of 75 g oral glucose tolerance test(OGTT),28 pregnant women with GDM(observation group)and 62 pregnant women with normal glucose tolerance(control group)were divided into two groups.Liquid chromatography-tandem mass spectrometry(LC-MS/MS)was used to detect the expression levels of serum tryptophan and proline in early pregnancy.Analysis of the correlation between the expression levels of serum tryptophan and proline in the first trimester of pregnant women with GDM and glucose metabolism indexes in the second trimester.Logistic regression was used to analyze the independent influencing factors of GDM.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of tryptophan and proline levels in early pregnancy for GDM.Results Compared with the control group,the levels of serum tryptophan(1.85±0.31μg/ml vs 2.14±0.28μg/ml)and proline(19.98±4.36μg/ml vs 25.23±5.00μg/ml)in the first trimester of the observation group decreased,the differences were statistically significant(t=-3.31,-3.90,all P<0.01).Compared with the control group,FBG(5.07±0.68 mmol/L vs 4.75±0.35 mmol/L),HbA1c(5.29%±0.22%vs 5.13%±0.29%),FINS(19.29±3.81μU/ml vs 12.52±2.59μU/ml)and HOMA-IR(2.63±0.19 vs 1.54±0.18)in the observation group were increased in the second trimester,and the differences were statistically significant(t=2.23~18.44,all P<0.05).Pearson correlation analysis showed that serum tryptophan and proline levels in the first trimester of pregnant women with GDM were negatively correlated with FBG,HbA1c,FINS and HOMA-IR in the second trimester(rtryptophan=-0.26,-0.24,-0.37,-0.45;rproline=-0.33,-0.47,-0.41,-0.49,all P<0.05).Serum tryptophan levels in early pregnancy were positively correlated with proline levels(r=0.455,P<0.05).Logistic regression analysis showed that serum tryptophan(OR=-0.355,95%CI:-0.456~-0.033)and proline(OR=-0.393,95%CI:-7.956~-1.039)were protective factors for the occurrence of GDM(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum tryptophan and proline levels in early pregnancy for predicting GDM was 0.750(95%CI:0.599~0.901)and 0.794(95%CI:0.651~0.937),respectively,2.12μg/ml and 23.22μg/ml were the optimal thresholds with 55%and 70%,and specificitres of 80%and 85%.The AUC of the combined detection of GDM was 0.825(95%CI 0.694~0.956),the sensitivity and specificity were 70%and 85%,respectively.Conclusion The expression levels of serum tryptophan and proline in pregnant women with GDM decreased in early pregnancy,and the detection of serum tryptophan and proline expression levels in early pregnancy has a certain predictive value for GDM.