孕晚期血清趋化因子CXCL12、RANTES、CCL2与妊娠糖尿病孕妇妊娠结局的相关性

Correlation of serum chemokines CXCL12,CCL2,RANTES in the third trimester of pregnancy and pregnancy outcome of pregnant women with gestational diabetes mellitus

目的 分析孕晚期血清趋化因子CXCL12、RANTES、CCL2与妊娠糖尿病(GDM)孕妇妊娠结局的相关性。方法 选取2021年2月至2022年6月期间南通市海门区人民医院收治的GDM孕妇125例作为GDM组,60名同期体检健康孕妇为对照组。根据GDM孕妇妊娠结局将孕妇分为良好妊娠结局组(95例)和不良妊娠结局组(30例)。比较GDM组和健康孕妇、良好妊娠结局组和不良妊娠结局组孕妇血清CXCL12、RANTES、CCL2水平;采用Pearson法分析血清CXCL12、RANTES、CCL2水平与FINS、FPG、HOMA-IR的相关性;采用Logistic回归分析GDM孕妇不良妊娠结局的影响因素;绘制ROC曲线,分析血清CXCL12、RANTES、CCL2水平对GDM孕妇不良妊娠结局的预测价值。结果 GDM孕妇血清CXCL12、RANTES、CCL2水平均显著高于健康孕妇,差异有统计学意义(P<0.05);良好妊娠结局组血清CXCL12、RANTES、CCL2水平显著低于不良妊娠结局组,差异有统计学意义(P<0.05);不同妊娠结局的GDM孕妇饮食偏好、TG、HDL-C、LDL-C、FINS、FPG、2hPG、HOMA-IR、HOMA-β、HbA1c、孕酮比较,差异有统计学意义(P<0.05)。GDM孕妇血清CXCL12与RANTES水平呈正相关(r=0.322,P<0.05),与CCL2水平呈正相关(r=0.401,P<0.05),RANTES与CCL2水平呈正相关(r=0.334,P<0.05);血清CXCL12、RANTES、CCL2水平与FINS、FPG、HOMA-IR呈正相关(P<0.05)。CXCL12、RANTES、CCL2、FINS、FPG、HOMA-IR水平升高为GDM孕妇不良妊娠结局的危险因素(P<0.05)。血清CXCL12、RANTES、CCL2水平联合评估GDM孕妇不良妊娠结局的AUC(0.936)显著高于三指标单独检测(AUC_(CXCL12)=0.811;AUC_(RANTES)=0.868;AUC_(CCL2)=0.796)(P<0.05)。结论血清CXCL12、RANTES、CCL2水平与GDM孕妇妊娠结局具有密切关系,可能可作为预测GDM孕妇不良妊娠结局的有效标志物。

Objective To analyze the correlation between the serum chemokines CXCL12,RAN-TES,CCL2 in the third trimester of pregnancy and pregnancy outcome in pregnant women with gestational dia-betes mellitus(GDM).Methods A total of 125 GDM pregnant women admitted to Nantong Haimen District Peoples Hospital from February 2021 to June 2022 were collected as the GDM group,and 60 healthy pregnant women who underwent physical examination during the same period were collected as the control group;accord-ing to the pregnancy outcomes of the GDM pregnant women,they were divided into a good pregnancy outcome group(95 cases)and a poor pregnancy outcome group(30 cases).Enzyme-linked immunosorbent assay(ELI-SA)was applied to detect and compare the levels of CXCL12,RANTES,and CCL2 in the GDM group and the healthy pregnant women,the good pregnancy outcome group and the poor pregnancy outcome group.Pearsons method was used to analyze the correlation between serum CXCL12,RANTES,CCL2 levels and FINS,FPG,HOMA-IR;Logistic regression was applied to analyze the factors influencing adverse pregnancy outcomes in GDM pregnant women.MedCalc was applied to draw the ROC curves,the predictive value of serum CXCL12,RANTES,and CCL2 levels for adverse pregnancy outcomes in GDM pregnant women was analyzed.Results The serum levels of CXCL12,RANTES,and CCL2 in GDM pregnant women were significantly higher than those in healthy pregnant women,with statistical significance(P<0.05).And the serum levels of CXCL12,RANTES,and CCL2 in the good pregnancy outcome group were significantly lower than those in the poor preg-nancy outcome group,with statistical significance(P<0.05).There were statistically obvious differences in di-etary preferences,TG,HDL-C,LDL-C,FINS,FPG,2hPG,HOMA-IR,HOMA-β,HbA1c,and progester-one among GDM pregnant women with different pregnancy outcomes(P<0.05).Serum CXCL12 levels in GDM pregnant women were positively correlated with RANTES levels(r=0.322,P<0.05),positively correlat-ed with CCL2 levels(r=0.401,P<0.05),and RANTES levels were positively correlated with CCL2 levels(r=0.334,P<0.05).Serum levels of CXCL12,RANTES,and CCL2 were positively correlated with FINS,FPG,and HOMA-IR(P<0.05).The increased levels of CXCL12,RANTES,CCL2,FINS,FPG,and HOMA-IR were all risk factors for adverse pregnancy outcomes in GDM pregnant women(P<0.05).The AUC(0.936)of the combination of serum CXCL12,RANTES,and CCL2 levels to evaluate adverse pregnancy outcomes in GDM pregnant women was significantly higher than that of CXCL12,RANTES,and CCL2 alone(AUCCXCL12=0.811;AUCRANTES=0.868;AUCCCL2=0.796)(P<0.05).Conclusion The serum levels of CXCL12,RANTES,and CCL2 are closely related to the pregnancy outcomes in pregnant women with GDM and may serve as effec-tive markers for predicting adverse pregnancy outcomes in pregnant women with GDM.