孕中期GDM患者血清Afamin和SFRP5水平及临床价值分析

Analysis of serum Afamin and SFRP5 levels and clinical value in mid-term GDM patients

目的分析孕中期妊娠期糖尿病(GDM)患者血清α清蛋白(Afamin)和分泌型卷曲相关蛋白5(SFRP5)水平及临床价值。方法选取2019年8月至2021年8月河北省秦皇岛市海港医院120例定期产检并分娩的孕妇为研究对象,其中GDM孕妇50例为GDM组,非GDM孕妇70例为对照组。采用酶联免疫吸附试验(ELISA)检测两组血清Afamin和SFRP5水平;采用口服葡萄糖耐量试验(OGTT)检测OGTT 1 h血糖(1 h PG)、OGTT 2 h血糖(2 h PG);检测空腹血糖(FPG)、糖化血红蛋白(HbA1c)及空腹胰岛素(FINS)水平;分析Afamin、SFRP5与糖代谢指标之间的相关性;采用受试者工作特征(ROC)曲线评估Afamin、SFRP5单独及联合检测对GDM的诊断价值;分析不同Afamin、SFRP5水平孕妇不良妊娠结局发生情况。结果GDM组FPG、1 h PG、2 h PG、HbA1c和FINS水平明显高于对照组,差异有统计学意义(P<0.05);GDM组Afamin水平明显高于对照组,SFRP5水平明显低于对照组,差异有统计学意义(P<0.05);Afamin水平与FPG、1 h PG、2 h PG、HbA1c和FINS水平呈正相关(P<0.05);SFRP5水平与FPG、1 h PG、2 h PG、HbA1c和FINS水平呈负相关(P<0.05);ROC曲线分析结果显示,血清Afamin和SFRP5单独及联合检测诊断GDM的曲线下面积(AUC)分别为0.747、0.642、0.872,且联合检测的灵敏度为89.3%,特异度为77.9%,联合检测的AUC明显大于单独检测的AUC,差异有统计学意义(P<0.05)。以所有孕妇的Afamin、SFRP5水平均值为界,分为高Afamin组、低Afamin组,以及高SFRP5组、低SFRP5组,高Afamin组母婴不良妊娠结局发生率高于低Af amin组,低SFRP5组母婴不良妊娠结局发生率高于高SFRP5组,差异有统计学意义(P<0.05)。结论Afamin和SFRP5作为诊断GDM的生物标志物具有良好的效能,在临床上可以预测GDM的发展趋势和不良妊娠结局的风险。

Objective To analyze the levels and clinical value of serum Afamin and secreted frizzled-related protein 5(SFRP5)in patients with gestational diabetes mellitus(GDM)in the second trimester.Methods A total of 120 pregnant women who received regular prenatal examination and delivered in Port Hospital of Qinhuangdao from August 2019 to August 2021 were selected as the research objects,including 50 GDM pregnant women as the GDM group and 70 non-GDM pregnant women as the control group.The serum Afamin and SFRP5 levels of the two groups were detected by enzyme-linked immunosorbent assay(ELISA).Oral glucose tolerance test(OGTT)was used to detect 1 h blood glucose(1 h PG)and 2 h blood glucose(2 h PG).Fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c)and fasting insulin(FINS)were measured.The correlation between Afamin,SFRP5 and glucose metabolism indexes was analyzed.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of Afamin and SFRP5 alone and combined detection for GDM.The adverse pregnancy outcomes of patients with different levels of Afamin and SFRP5 were analyzed.Results The levels of FPG,1 h PG,2 h PG,HbA1c and FINS in GDM group were significant higher than those in control group(P<0.05).The level of Afamin in GDM group was significant higher than that in control group,and the level of SFRP5 in GDM group was significant lower than that in control group(P<0.05).Afamin level correlated positively with FPG,1 h PG,2 h PG,HbA1c and FINS levels(P<0.05).SFRP5 level correlated negatively with FPG,1 h PG,2 h PG,HbA1c and FINS(P<0.05).The results of ROC curve showed that the area under the curve(AUC)of serum Afamin and SFRP5 alone and combined detection in the diagnosis of GDM were 0.747,0.642,0.872 respectively,the sensitivity of combined detection was 89.3%,and the specificity of combined detection was 77.9%.The AUC of combined detection was significantly higher than that of single detection,the difference was statistically significant(P<0.05).According to the mean Afamin and SFRP5 levels of all pregnant women,they were divided into high Afamin group and low Afamin group,high SFRP5 group and low SFRP5 group.The incidence rate of maternal and infant adverse pregnancy outcomes in high Afamin group was higher than that in low Afamin group,and the incidence rate of maternal and infant adverse pregnancy outcomes in low SFRP5 group was higher than that in high SFRP5 group,the differences were statistically significant(P<0.05).Conclusion Afamin and SFRP5 as biological markers for GDM prediction have good efficacy,which can be used in clinical practice to predict the development trend and risk of adverse pregnancy outcomes of gestational diabetes mellitus.