妊娠期糖尿病孕妇血清胰腺衍生因子和妊娠相关蛋白A及微小RNA-21表达水平与胰岛素抵抗及妊娠结局的关系

The relationship between the expression levels of serum pancreas derived factor, pregnancy associated plasma protein A and microRNA-21 in pregnant women with gestational diabetes mellitus and insulin resistance and pregnancy outcome

目的 探讨妊娠期糖尿病(GDM)孕妇血清胰腺衍生因子(PANDER)、妊娠相关蛋白A(PAPP-A)、微小RNA-21(miR-21)表达水平与胰岛素抵抗及妊娠结局的关系。方法 选取2019年8月至2022年8月西北妇女儿童医院收治的154例GDM孕妇作为GDM组,并根据妊娠结局分为不良妊娠组(35例)、良好妊娠组(119例);另按1∶1比例选取同期产检健康孕妇154例为对照组。比较各组血清PANDER、PAPP-A、miR-21水平及稳态模型胰岛素抵抗指数(HOMA-IR);采用Pearson相关系数分析GDM孕妇血清miR-21、PANDER、PAPP-A水平与HOMA-IR的相关性;采用多因素Logistic回归分析GDM孕妇发生不良妊娠结局的影响因素;采用受试者工作特征(ROC)曲线分析血清PANDER、PAPP-A、miR-21预测GDM孕妇不良妊娠结局的价值。结果 GDM组HOMA-IR、PANDER、PAPP-A、miR-21水平均高于对照组(均P<0.001)。GDM孕妇PANDER、PAPP-A、miR-21水平与HOMA-IR均呈正相关(r=0.251、0.270、0.326,均P<0.001)。Logistic回归分析显示空腹血糖、HOMA-IR、PANDER、PAPP-A、miR-21水平高是GDM孕妇发生不良妊娠结局的危险因素(均P<0.05)。ROC曲线分析结果显示,PANDER、PAPP-A、miR-21预测GDM孕妇不良妊娠结局的曲线下面积(AUC)分别为0.776、0.788、0.726,三项指标联合预测的AUC为0.943。结论 GDM孕妇血清PANDER、PAPP-A、miR-21表达水平升高,且与胰岛素抵抗及妊娠结局均具有相关性,PANDER、PAPP-A、miR-21联合检测有助于提高对GDM孕妇不良妊娠结局的预测效能。

Objective To investigate the relationship between the expression levels of serum pancreas derived factor(PANDER),pregnancy associated plasma protein A(PAPP-A)and microRNA-21(miR-21)in pregnant women with gestational diabetes mellitus(GDM)and insulin resistance and pregnancy outcome.Methods A total of 154 pregnant women with GDM admitted to Northwest Women′s and Children′s Hospital from August 2019 to August 2022 were selected as the GDM group,and according to the pregnancy outcome,they were divided into adverse pregnancy group(35 cases)and good pregnancy group(119 cases).Another 154 healthy pregnant women who underwent prenatal examination in the same period were selected as the control group at a ratio of 1∶1.The levels of serum PANDER,PAPP-A and miR-21 and homeostasis model assessment of insulin resistance(HOMA-IR)were compared among the groups.Pearson correlation coefficient was used to analyze the correlation between serum PANDER,PAPP-A,miR-21 levels and HOMA-IR in pregnant women with GDM.Multivariate Logistic regression was used to analyze the influencing factors of adverse pregnancy outcomes in pregnant women with GDM.Receiver operating characteristic(ROC)curve was used to analyze the value of serum PANDER,PAPP-A and miR-21 in predicting adverse pregnancy outcomes in pregnant women with GDM.Results The levels of HOMA-IR,PANDER,PAPP-A,and miR-21 in the GDM group were higher than those in the control group(all P<0.001).The levels of PANDER,PAPP-A and miR-21 in pregnant women with GDM were positively correlated with HOMA-IR(r=0.251,0.270,0.326,all P<0.001).Logistic regression analysis showed that the high levels of fasting blood glucose,HOMA-IR,PANDER,PAPP-A and miR-21 were the risk factors for adverse pregnancy outcomes in pregnant women with GDM(all P<0.05).ROC curve analysis showed that the area under the curve of PANDER,PAPP-A and miR-21 in predicting adverse pregnancy outcomes in pregnant women with GDM was 0.776,0.788 and 0.726,respectively,and the area under the curve of combined prediction of the three indexes was 0.943.Conclusions The levels of serum PANDER,PAPP-A and miR-21 in pregnant women with GDM are increased,and they are related to insulin resistance and pregnancy outcomes.The combined detection of PANDER,PAPP-A and miR-21 can improve the efficacy of predicting adverse pregnancy outcomes in pregnant women with GDM.