孕早期妊娠相关血浆蛋白A等多指标联合预测妊娠期糖尿病的价值

Predictive Value of Multiple Indicators such as Pregnancy-Associated Plasma Protein A in Early Pregnancy for Gestational Diabetes Mellitus

目的:探讨孕早期妊娠相关血浆蛋白A(PAPP-A)、空腹血糖(FPG)、体质量指数(BMI)和年龄对妊娠期糖尿病(GDM)的预测价值。方法:选择2021年12月至2022年6月在四川省妇幼保健院进行产前检查并分娩的孕妇792例进行回顾性分析,按是否患GDM分为GDM组(232例)和对照组(560例),比较两组孕妇临床资料、早孕期血清PAPP-A中位数倍数(PAPP-A MoM)和FPG水平的差异。将单因素分析有统计学意义的指标纳入多因素Logistic回归分析,分析影响GDM发生的相关因素。绘制不同指标的受试者工作曲线(ROC)和曲线下面积(AUC),比较预测GDM的效能。结果:①GDM组年龄、孕前体质量指数(BMI)、孕早期FPG和采用辅助生殖技术受孕比例高于对照组,差异有统计学意义(P<0.05);GDM组孕早期PAPP-A MoM低于对照组,差异有统计学意义(P<0.05)。②多因素Logistic回归分析显示年龄增大、孕前BMI升高、孕早期FPG升高为GDM发生的独立危险因素(OR>1,P<0.05),而孕早期PAPP-A MoM升高为保护性因素(OR<1,P<0.05)。③ROC示:孕早期PAPP-A MoM+孕早期FPG+孕前BMI+年龄4项指标联合预测GDM时AUC最大(0.752),敏感度为55.6%,特异度为84.3%。结论:孕早期进行血清学(PAPP-A+FPG)和临床资料(孕前BMI+年龄)的联合筛查预测GDM具有一定的临床应用前景,可推广使用。

Objective:To investigate the predictive value of pregnancy-associated plasma protein A(PAPP-A),fasting blood glucose(FPG),body mass index(BMI)and age in gestational diabetes mellitus(GDM)during the first trimester.Methods:A retrospective analysis was performed on 792 pregnant women who underwent prenatal examination and delivered in Sichuan Provincial Maternal and Child Health Care Hospital from December 2021 to June 2022.They were divided into GDM group(232 cases)and control group(560 cases)according to whether they had GDM.The clinical data,serum PAPP-A median multiple(PAPP-A MoM)in early pregnancy and FPG levels were compared between the two groups.The indicators with statistical significance in univariate analysis were included in multivariate Logistic regression analysis to analyze the related factors affecting the occurrence of GDM.The receiver operating curve(ROC)and area under the curve(AUC)of different indexes were plotted to compare the efficacy of GDM prediction.Results:①The age,pre pregnancy BMI,early pregnancy FPG and the proportion of assisted reproductive technology in GDM group were higher than those in control group,and the differences were statistically significant(P<0.05).The early pregnancy PAPP-A MoM level in GDM group was lower than that in control group,and the difference was statistically significant(P<0.05).②Multivariate Logistic regression analysis showed that older age,lager pre-pregnancy BMI and lager FPG in the first trimester were independent risk factors for GDM occurrence(OR>1,P<0.05),while an increase of PAPP-A MoM in the first trimester was a protective factor(OR<1,P<0.05).③ROC showed that the combination of PAPP-A MoM in early pregnancy,FPG in early pregnancy,BMI in pre-pregnancy and age had the highest AUC(0.752)when predicting GDM,with a sensitivity of 55.6%and a specificity of 84.3%.Conclusions:The combined screening of serological(PAPP-A+FPG)and clinical data(pre-pregnancy BMI+age)in early pregnancy has a high clinical application prospect and can be popularized.