妊娠期糖尿病孕妇血清SFRP-4、HSP60水平对不良妊娠结局的预测价值

Serum SFRP-4 and HSP60 levels in pregnant women with gestational diabetes mellitus and their predictive value for adverse pregnancy outcomes

目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇血清分泌型卷曲相关蛋白-4(secreted frizzled-related protein-4,SFRP-4)、热休克蛋白60(heat shock protein 60,HSP60)水平对不良妊娠结局的预测价值。方法选择2020年6月至2022年8月濮阳市人民医院收治的123例GDM孕妇作为观察组,选择同期在本院进行产检的健康孕妇120例作为对照组。酶联免疫吸附法(ELISA)检测血清SFRP-4、HSP60水平,收集入选人员临床资料,采用Pearson法分析血清SFRP-4、HSP60水平与糖脂代谢指标的相关性,ROC曲线分析血清SFRP-4、HSP60对GDM患者不良妊娠结局诊断价值。结果对照组与GDM组年龄、孕前体质指数(body mass index,BMI)、孕周、孕次及血清高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)比较,差异无统计学意义(P>0.05);GDM组空腹血糖(fasting blood glucose,FBG)、空腹胰岛素(fasting insulin,FINS)、糖化血红蛋白(glycosylated hemoglobin type A1c,HbA1c)、胰岛素抵抗指数(homeostatic model assessment of insulin resistance,HOMA-IR)、甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)显著高于对照组(6.41±0.73)vs(4.98±0.61)mmol/L、(12.35±2.33)vs(7.61±1.56)mIU/L、(9.34±1.26)%vs(5.74±0.23)%、(3.42±0.55)vs(1.27±0.53)、(1.74±0.82)vs(1.21±0.23)mmol/L、(4.98±1.21)vs(4.57±1.13)mmol/L(P<0.05)。GDM组患者血清SFRP-4、HSP60水平显著高于对照组(5.68±1.78)vs(3.26±0.95)ng/mL、(32.56±6.28)vs(18.42±3.24)ng/mL(P<0.05)。GDM患者血清SFRP-4、HSP60与FBG、FINS、HbA1c、HOMA-IR呈正相关(P<0.05),与TG、TC、HDL-C、LDL-C无关(P>0.05)。与妊娠结局良好组比较,不良组血清SFRP-4、HSP60水平显著升高(7.41±1.62)vs(4.75±1.55)ng/mL、(38.31±5.76)vs(29.47±5.41)ng/mL(P<0.05)。血清SFRP-4、HSP60联合诊断GDM患者不良妊娠结局的AUC为0.931,敏感度为86.05%,特异度为87.50%,联合诊断效能高于单独检测(Z=2.070,P=0.038;Z=2.001,P=0.045)。结论GDM患者血清SFRP-4、HSP60水平升高,与GDM妊娠结局相关,二者联合对GDM患者不良妊娠结局有一定诊断价值。

Objective To investigate the serum levels of secreted frizzled-related protein-4(SFRP-4)and heat shock protein 60(HSP60)in pregnant women with gestational diabetes mellitus(GDM)and their predictive value for adverse pregnancy outcomes.Methods A total of 123 pregnant women with GDM who were admitted from Jun.2020 to Aug.2022 were collected as the observation group,and 120 healthy pregnant women who underwent obstetric examination in our hospital were gathered as the control group.Serum SFRP-4 and HSP60 levels were detected by enzyme-linked immunosorbent assay(ELISA),clinical data of selected persons were collected;Pearson method was used to analyze the correlation between serum SFRP-4 and HSP60 levels and glucose and lipid metabolism indexes;ROC curve was used to analyze the serum SFRP-4 and HSP60 in the diagnosis of adverse pregnancy outcomes in patients with GDM.Results There were no obvious differences in age,pre-pregnancy BMI,gestational age,pregnancy times,and serum HDL-C or LDL-C between the control group and the GDM group(P>0.05).FBG,FINS,HbA1c,HOMA-IR,TG,and TC in GDM group were obviously higher than those in control group[(6.41±0.73)vs(4.98±0.61)mmol/L,(12.35±2.33)vs(7.61±1.56)mIU/L,(9.34±1.26)vs(5.74±0.23)%,(3.42±0.55)vs(1.27±0.53),(1.74±0.82)vs(1.21±0.23)mmol/L,(4.98±1.21)vs(4.57±1.13)mmol/L](P<0.05).The levels of serum SFRP-4 and HSP60 in the GDM group were obviously higher than those in the control group[(5.68±1.78)vs(3.26±0.95)ng/mL,(32.56±6.28)vs(18.42±3.24)ng/mL](P<0.05);Serum SFRP-4 and HSP60 in GDM patients were positively correlated with FBG,FINS,HbA1c,and HOMA-IR(P<0.05),but had nothing to do with TG,TC,HDL-C,and LDL-C(P>0.05).Compared with the good pregnancy outcome group,the serum SFRP-4 and HSP60 levels in the poor group were obviously increased[(7.41±1.62)vs(4.75±1.55)ng/mL,(38.31±5.76)vs(29.47±5.41)ng/mL](P<0.05).The AUC of serum SFRP-4 combined HSP60 to diagnose adverse pregnancy outcomes in GDM patients was 0.931,with a sensitivity of 86.05% and a specificity of 87.50%.The combined diagnostic performance was higher than that of the single test(Z=2.070,P=0.038;Z=2.001,P=0.045).Conclusions The levels of serum SFRP-4 and HSP60 in GDM patients are increased,which are related to GDM pregnancy outcomes.The combination of the two has certain diagnostic value for adverse pregnancy outcomes in GDM patients.