妊娠期糖尿病126例孕中期血清C1q/肿瘤坏死因子相关蛋白5、C1q/肿瘤坏死因子相关蛋白9水平变化及意义

Changes and significance of serum CTRP5 and CTRP9 levels in the second trimester of gestational diabetes:a study of 126 cases

目的分析孕中期血清C1q/肿瘤坏死因子相关蛋白5(CTRP5)、C1q/肿瘤坏死因子相关蛋白9(CTRP9)水平对妊娠期糖尿病(GDM)病人围生儿不良结局的预测价值。方法选取秦皇岛市妇幼保健院2019年1月至2020年5月收治的128例GDM病人和125例健康孕妇,分别记为疾病组和对照组。两组均采用酶联免疫法(ELISA)检测孕中期血清CTRP5、CTRP9水平,比较两组不良结局、孕中期血清CTRP5、CTRP9水平差异。比较疾病组结局良好与结局不良病人孕中期血清CTRP5、CTRP9水平,采用logistic回归分析探讨疾病组结局不良的影响因素。绘制受试者操作特征(ROC)曲线,并用曲线下面积(AUC)评价血清CTRP5、CTRP9单独及联合对疾病组围生儿不良结局的预测效能。结果疾病组有2例失访,对照组有1例失访,均剔除本研究,最终纳入本研究疾病组126例,对照组124例。疾病组围生儿不良结局发生率为19.05%(24/126)高于对照组2.42%(3/124)(P<0.05);疾病组孕中期血清CTRP5水平(41.47±8.04)μg/L高于对照组(21.06±4.55)μg/L,疾病组血清CTRP9水平(101.25±22.36)ng/L低于对照组(157.83±29.73)ng/L,均差异有统计学意义(P<0.05)。高龄产妇、糖尿病家族史、孕前BMI、孕中期血清CTRP5水平、治疗依从、孕中期血清CTRP9水平均是疾病组围生儿不良结局的影响因素;孕中期血清CTRP5、CTRP9水平联合预测围生儿不良结局,疾病组围生儿不良结局母体孕中期血清CTRP5水平(73.69±8.76)μg/L高于围生儿结局良好母体(33.89±4.15)μg/L(t=33.00,P<0.001),血清CTRP9水平(60.88±12.71)ng/L低于围生儿结局良好母体(110.75±23.58)ng/L(t=10.00,P<0.001)。结论GDM病人孕中期血清CTRP5水平偏高,CTRP9水平偏低,二者均是围生儿不良结局的影响因素,且联合预测该不良事件的效能高。

Objective To analyze the predictive value of serum levels of C1q/tumor necrosis factor related protein 5(CTRP5)and C1q/tumor necrosis factor related protein 9(CTRP9)in the second trimester of pregnancy for perinatal adverse outcomes in patients with gestational diabetes mellitus(GDM).Methods A total of 128 GDM patients and 125 healthy pregnant women admitted to Qinhuangdao Maternal and Child Health Hospital from January 2019 to May 2020 were selected and recorded as disease group and control group,respectively.The serum levels of CTRP5 and CTRP9 in the second trimester of pregnancy were detected by enzyme-linked immunosorbent assay(ELISA).The incidences of adverse perinatal outcomes,serum levels of CTRP5 and CTRP9 in the second trimester of pregnancy were compared between the two groups.The serum levels of CTRP5 and CTRP9 in the second trimester of pregnancy were compared between patients with good and poor outcomes in the disease group.Logistic regression analysis was made to explore the influencing factors of poor outcomes in the disease group.The receiver operating characteristic curve(ROC)was drawn,and the area under the curve(AUC)was used to evaluate the predictive effect of serum CTRP5 and CTRP9 on perinatal adverse outcomes in the disease group separately and jointly.Results Two patients were lost to follow-up in the disease group and one in the control group,who were excluded from this study,and 126 patients in the disease group and 124 in the control group were included in the study.The incidence of adverse perinatal outcomes in the disease group was 19.05%(24/126),which was higher than that in the control group(2.42%,3/124),with a statistically significant difference(P<0.05).The level of serum CTRP5 in the second trimester of pregnancy in the disease group was higher than that in the control group[(41.47±8.04)μg/L vs.(21.06±4.55)μg/L],while the level of serum CTRP9 in the disease group was lower than that in the control group[(101.25±22.36)ng/L vs.(157.83±29.73)ng/L],with statistically significant differences(P<0.05).Elderly parturient women,family history of diabetes,pre-pregnancy BMI,serum CTRP5 and CTRP9 levels in the second trimester of pregnancy,and treatment compliance were all factors influencing perinatal adverse outcomes in the disease group.The serum CTRP5 and CTRP9 levels were used jointly to predict adverse outcomes in perinatal infants.Serum CTRP 5 level was higher than those with perinatal good outcomes[(73.69±8.76)μg/L vs.(33.89±4.15)μg/L](t=33.00,P<0.001),while serum CTRP 9 level in parturient women with perinatal adverse outcomes in the disease group was lower than those with perinatal good outcomes[(60.88±12.71)ng/L vs.(110.75±23.58)ng/L](t=10.00,P<0.001).Conclusions The serum level of CTRP5 in GDM patients in the second trimester of pregnancy is higher than those healthy pregnant women,and the serum level of CTRP9 is lower.Both of them are the influencing factors of perinatal adverse outcomes,and the combined use of them for the prediction of the adverse events is more effective.