孕早期血清铁蛋白、孕前体质量指数联合孕龄对妊娠糖尿病的预测价值

Predictive value of serum ferritin in early gestation,pre-pregnancy body mass index and gestational age for gestational diabetes mellitus

目的探讨孕早期血清铁蛋白(serum ferritin,SF)、孕前体质量指数(body mass index,BMI)及孕龄对妊娠糖尿病(gestational diabetes mellitus,GDM)的预测价值。方法选取2021年1月至2022年12月于温州市人民医院定期产检的260名孕妇为研究对象。首次产检时(孕14周内)采集孕妇空腹静脉血测定SF;孕24~28周时进行75g口服葡萄糖耐量试验(oral glucose tolerance test,OGTT),根据OGTT结果将孕妇分为GDM组(n=62)和糖耐量正常组(normal glucose tolerance,NGT组)(n=198)。比较两组孕妇的一般资料,利用Logistic回归和受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析孕早期SF、孕前BMI、孕龄与GDM的相关性。结果GDM组孕妇孕早期SF水平高于NGT组孕妇,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,孕龄、孕早期SF、孕前肥胖是GDM发生的独立危险因素(P<0.05)。孕早期SF水平、孕前BMI、孕龄预测GDM的曲线下面积(area under the curve,AUC)分别为0.612、0.691、0.664,最佳截断值分别为94.045ng/ml、21.125kg/m^(2)、28.500岁;三者联合预测GDM的AUC为0.750,敏感度和特异性分别为66.1%及79.3%。结论孕早期SF水平、孕前BMI、孕龄是发生GDM的重要影响因素,联合检测对GDM有一定的预测价值。

Objective To investigate the predictive value of serum ferritin(SF)in early gestation,pre-pregnancy body mass index(BMI)and gestational age for gestational diabetes mellitus(GDM).Methods A total of 260 pregnant women who had a routine prenatal examination in Wenzhou People’s Hospital were collected from January 2021 to December 2022.Fasting venous blood was collected at the first prenatal examination(within 14 weeks’gestation)for SF.According to the results of 75 grams oral glucose tolerance test(OGTT)between 24 weeks and 28 weeks,they were divided into GDM group(n=62)and normal glucose tolerance(NGT)group(n=198).The general clinical data of the two groups were compared;Multivariate Logistic regression analysis was conducted to determine the independent risk factors of GDM.Receiver operating characteristic(ROC)curve was used to further analyze the predictive value of SF in early gestation,pre-pregnancy BMI and gestational age for GDM.Results Pregnant women in GDM group had higher SF,BMI and gestational age in early pregnancy than those of NGT group(P<0.05).Pre-pregnancy BMI,gestational age and SF increased in early pregnancy were independent risk factors for GDM(P<0.05).The area under the curve(AUC)of SF in early pregnancy as well as pre-pregnancy BMI and gestational age for predicting GDM were 0.612,0.691 and 0.664.The best tangent point values were 94.045ng/ml,21.125kg/m^(2) and 28.500 years old,respectively.The total AUC of ROC predicted GDM by SF in early gestation,pre-pregnancy BMI and gestational age was 0.750,the sensitivity and specificity were 66.1%and 79.3%,respectively.Conclusion SF in early gestation,pre-pregnancy BMI and gestational age are important factors in the development of GDM,the combined detection of SF in early pregnancy,pre-pregnancy BMI and gestational age has a certain predictive value for GDM.