脐带血PPARγ、IGF-1R和FABP4水平在妊娠期糖尿病患者发生新生儿脑损伤中的诊断价值

Diagnostic value of umbilical cord blood levels of PPARγ,IGF-1R and FABP4 in neonatal brain injury in gestational diabetes mellitus patients

目的 探讨脐带血过氧化物酶体增殖物激活受体γ(PPARγ)、胰岛素样生长因子1受体(IGF-1R)和脂肪细胞型脂肪酸结合蛋白4(FABP4)水平在妊娠期糖尿病(GDM)患者发生新生儿脑损伤中的诊断价值。方法 选取2020年1月至2022年12月在该院诊治的493例GDM患者作为GDM组,另选取同期本院75例正常妊娠者作为对照组。观察GDM组和对照组脐带血PPARγ、IGF-1R和FABP4水平,分析GDM患者发生新生儿脑损伤的单因素和多因素,以及血清PPARγ、IGF-1R和FABP4水平在GDM患者发生新生儿脑损伤中的诊断价值。结果 GDM组脐带血PPARγ水平明显低于对照组,而脐带血IGF-1R和FABP4水平均明显高于对照组,差异均有统计学意义(P<0.05)。GDM合并脑损伤组脐带血血糖(BG)、IGF-1R和FABP 4水平均明显高于GDM非脑损伤组,脐带血PPARγ水平明显低于GDM非脑损伤组,差异均有统计学意义(P<0.05);GDM合并脑损伤组和GDM非脑损伤组年龄、孕前体质量指数、孕次、产妇类型、分娩方式、新生儿性别、新生儿出生体质量和糖化血红蛋白水平比较,差异均无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,脐带血BG、IGF-1R和FABP4水平升高是GDM发生新生儿脑损伤的危险因素(P<0.05);PPARγ水平升高是GDM发生新生儿脑损伤的保护因素(P<0.05)。脐带血PPARγ、IGF-1R和FABP4水平在GDM患者发生新生儿脑损伤中的诊断效能明显高于BG,PPARγ、IGF-1R和FABP4 3项指标联合检测的灵敏度为94.3%,特异度为88.9%,受试者工作特征曲线下面积(AUC)为0.972,明显高于PPARγ(Z=3.819,P<0.001)、IGF-1R(Z=3.319,P=0.001)和FABP4(Z=3.300,P=0.001)单项检测,而3项指标之间的AUC比较,差异无统计学意义(P>0.05)。结论 脐带血PPARγ、IGF-1R和FABP4水平在GDM患者发生新生儿脑损伤诊断中具有重要参考价值,3项指标联合检测的诊断效能优于单项检测。

Objective To investigate the diagnostic value of umbilical cord blood levels of peroxisome proliferator-activated receptorγ(PPARγ),insulin-like growth factor 1 receptor(IGF-1R)and adipocyte fatty acid binding protein 4(FABP4)in neonatal brain injury in gestational diabetes mellitus(GDM)patients.Methods A total of 493 GDM patients diagnosed and treated in the hospital from January 2020 to December 2022 were selected as the GDM group,and 75 normal pregnant women in the same hospital during the same period were selected as the control group.The levels of PPARγ,IGF-1R and FABP4 in the cord blood of the GDM group and the control group were observed,and the univariate and multivariate factors of neonatal brain injury in GDM patients were analyzed,and the diagnostic value of serum PPARγ,IGF-1R and FABP4 levels in GDM patients with neonatal brain injury was analyzed.Results The level of PPARγin cord blood of the GDM group was significantly lower than that of the control group,while the levels of IGF-1R and FABP4 in cord blood were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).The levels of blood glucose(BG),IGF-1R and FABP 4 in the GDM with brain injury group were significantly higher than those in the GDM without brain injury group,and the level of PPARγin the cord blood was significantly lower than that in the GDM without brain injury group(P<0.05).There was no significant difference in age,pre-pregnancy body mass index,gravidity,maternal type,delivery mode,neonatal gender,neonatal birth weight and glycosylated hemoglobin level between the GDM with brain injury group and the GDM without brain injury group(P>0.05).Multivariate Logistic regression analysis showed that increased umbilical cord blood BG,IGF-1R and FABP4 levels were risk factors for neonatal brain injury in GDM patients(P<0.05).The increased PPARγlevel was a protective factor for neonatal brain injury in GDM patients(P<0.05).The diagnostic efficacy of umbilical cord blood PPARγ,IGF-1R and FABP4 levels in GDM patients with neonatal brain injury was significantly higher than that of BG.The sensitivity and specificity of combined detection of PPARγ,IGF-1R and FABP4 were 94.3%and 88.9%,respectively.The area under the receiver operating characteristic curve(AUC)was 0.972,which was significantly higher than that of PPARγ(Z=3.819,P<0.001),IGF-1R(Z=3.319,P=0.001)and FABP4(Z=3.300,P=0.001)alone,and there was no significant difference in AUC among the 3 indicators(P>0.05).Conclusion The levels of PPARγ,IGF-1R and FABP4 in cord blood have important reference value in the diagnosis of neonatal brain injury in GDM patients,and the diagnostic efficacy of combined detection of the 3 indicators is better than that of individual detection.