摘要
目的:观察血清环磷酸腺苷反应元件结合蛋白调节转录辅激活因子3(CRTC3)、脂肪酸结合蛋白4(FABP4)和载脂蛋白CⅢ(apo CⅢ)水平对妊娠期糖尿病(GDM)患者妊娠结局的预测价值。方法:选择2021年1月至2022年6月在我院诊治的GDM患者118例,为GDM组。选择同期在我院就诊的正常妊娠孕妇75例,为对照组。比较两组孕妇血清CRTC3、apo CⅢ和FABP4水平的差异;探讨GDM组患者血清CRTC3、apo CⅢ和FABP4水平与血糖控制程度的关系;开展GDM患者不良妊娠结局影响因素的单因素和多因素分析,探讨发生不良妊娠结局的独立危险因素;探讨血清CRTC3、apo CⅢ和FABP4水平在预测GDM患者妊娠结局的诊断效能。结果:GDM组患者血清CRTC3、apo CⅢ和FABP4水平均高于对照组(P<0.01),并随着GDM控制程度提升而降低。妊娠结局不良组GDM患者年龄、孕前BMI水平、不良孕产史、血糖控制情况、TG、CRTC3、apo CⅢ和FABP4水平与妊娠结局良好组相比,差异均有统计学意义(P<0.01),而两组患者产次、血清TC、HDL-C和LDL-C水平差异均无统计学意义(P>0.05)。多因素分析结果发现血清CRTC3、apo CⅢ和FABP4水平升高是GDM患者发生不良妊娠结局的独立危险因素(P<0.05)。血清CRTC3、apo CⅢ和FABP4水平在预测GDM患者发生不良妊娠结局具有较高的诊断效能,联合检测的灵敏度为92.6%,特异度为89.0%,AUC为0.956,均高于单个指标CRTC3(z=2.559,P=0.010)、apo CⅢ(z=3.212,P=0.001)和FABP4(z=2.687,P=0.007),而3个指标之间的AUC比较差异无统计学意义(P>0.05)。结论:血清CRTC3、apo CⅢ和FABP4水平参与了GDM的发生发展,是GDM患者发生不良妊娠结局的独立危险因素,联合检测有助于提高对不良妊娠结局的诊断效能。
Objective:To investigate the predictive value of CREB regulated transcription coactivator 3(CRTC3),fatty acid binding protein 4(FABP4)and apo CⅢfor adverse pregnancy outcomes in patients with gestational diabetes mellitus(GDM).Methods:118 patients with GDM treated in our hospital from January 2021 to June 2022 were selected as the GDM group.75 normal pregnant women treated in our hospital during the same period were selected as the control group.The serum levels of CRTC3,apo CⅢand FABP4 were compared between the two groups.The relationship between serum CRTC3,apo CⅢand FABP4 levels and the degree of blood glucose control was discussed.The univariate and multivariate analysis of the influencing factors of adverse pregnancy outcomes in GDM patients were analyzed.The diagnostic efficacy of serum CRTC3,apo CⅢand FABP4 levels in predicting adverse pregnancy outcomes in GDM patients was performed.Results:The serum levels of CRTC3,apo CⅢand FABP4 in GDM group were higher than those in the control group(P<0.01),and decreased with the increase of GDM control degree.There was significant difference in the age,pre-pregnancy BMI,adverse pregnancy history,poor blood glucose control,TG,CRTC3,apo CⅢand FABP4 levels of patients in the poor pregnancy outcome group and the good pregnancy outcome group(P<0.01).There were no significant differences in the parity,serum TC,HDL-C and LDL-C levels between the two groups of patients(P>0.05).Multivariate analysis showed that increased serum levels of CRTC3,apo CⅢand FABP4 were independent risk factors for adverse pregnancy outcomes(P<0.05).Serum CRTC3,apo CⅢand FABP4 levels had high diagnostic efficacy in the prediction of adverse pregnancy outcomes in GDM patients.The sensitivity and specificity of combined detection respectively were 92.6%,89.0%and AUC was 0.956,which were significantly higher than that of CRTC3(z=2.559,P=0.010),apo CⅢ(z=3.212,P=0.001)and FABP4(z=2.687,P=0.007),while there was no significant difference in AUC among the three indexes(P>0.05).Conclusion:Serum CRTC3,apo CⅢand FABP4 levels are involved in the occurrence and development of GDM,and are independent risk factors for adverse pregnancy outcomes in GDM patients.Combined detection is helpful to improve the diagnostic efficacy for adverse pregnancy outcomes.
作者
王芸
WANG Yun(Department of Obstetrics,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200090,China)
出处
《中国医药导刊》
2023年第7期744-749,共6页
Chinese Journal of Medicinal Guide