孕期炎症因子变化对妊娠期高血糖患者并发子痫前期的预测价值

The predictive values of changes in inflammatory factors during pregnancy for preeclampsia in patients with gestational hyperglycemia

目的分析孕期炎症因子变化对妊娠期高血糖患者并发子痫前期(PE)的预测价值。方法选取202例妊娠期高血糖患者,按是否发生PE分为PE组(n=49)和对照组(n=153)。比较两组患者的妊娠结局、空腹血糖、糖化血红蛋白、空腹胰岛素(FIN)、稳态模型胰岛素抵抗指数(HOMA-IR)以及炎症因子水平。采用Logistic回归分析妊娠高血糖合并PE的影响因素,ROC分析炎症因子对PE的预测价值。结果与对照组比较,PE组孕周和新生儿Apgar评分降低,胎膜早破、产后出血、产间发热、早产儿、胎儿窘迫、胎儿低血糖的比例、FIN、HOMA-IR、血清炎症因子水平升高(P<0.05)。血清炎症因子是PE发生的危险因素,同种炎症因子孕中期水平预测PE的AUC均高于孕早期,血清肿瘤坏死因子-α(TNF-α)水平预测PE的AUC最高,孕中期血清TNF-α水平预测PE的灵敏度和特异度为79.59%和96.08%。结论妊娠期高血糖并发PE患者孕期血清炎症因子水平升高,可能与胰岛素抵抗程度有关,检测血清炎症因子水平对于预测PE的发生均有辅助价值。

Aim To analyze the predictive values of changes in inflammatory factors during pregnancy for preeclampsia(PE)in patients with gestational hyperglycemia.Methods 202 patients with gestational hyperglycemia were selected and divided into PE group(n=49)and a control group(n=153)based on PE occurrences.The pregnancy outcomes,fasting blood glucose,glycosylated hemoglobin,fasting insulin(FIN),homeostasis model assessment-insulin resistance index(HOMA-IR)and the serum inflammatory factor levels between the two groups were compared.The Logistic regression was used to analyze the influencing factors of gestational hyperglycemia combined with PE,and the predictive value of inflammatory factors on PE were analyzed by ROC.Results Compared with the control group,the neonatal Apgar score and gestational age in the PE group were decreased,while the proportion of premature rupture of membranes,postpartum hemorrhage,postpartum fever,premature infants,fetal distress,fetal hypoglycemia,FIN,HOMA-IR,and serum inflammatory factor levels were increased(P<0.05).Serum inflammatory factors were the risk factor for the occurrence of PE,and the AUC of PE predicted by the levels of the same inflammatory factors in mid pregnancy was higher than that in early pregnancy.Serum tumor necrosis factor alpha(TNF-α)levels predicted the highest AUC of PE,and the sensitivity and specificity of TNF-αlevels during mid pregnancy in predicting PE were 79.59%and 96.08%,respectively.Conclusion The patients with gestational hyperglycemia complicated with PE can exhibit elevated levels of serum pro-inflammatory factors,which may be related to the degree of insulin resistance.The detection of serum levels of inflammatory factors has an auxiliary value in predicting the occurrence of PE.