妊娠期糖尿病患者血清miR-217、DKK1水平对妊娠结局的预测价值探讨

Exploring the predictive value of serum microRNA-217,Dickkopf-l levels to the outcome of pregnancy in gestational diabetes patients

目的探讨妊娠期糖尿病(GDM)患者血清微小RNA-217(miR-217)和分泌型蛋白Dickkopf-l(DKK1)水平与妊娠结局的关系及对妊娠结局的预测价值。方法选取2021年4月至2023年4月在大连市妇女儿童医疗中心进行定期产检并分娩的97例GDM患者作为GDM组,选取同期同院91例体检健康孕妇作为对照组。采用实时荧光定量聚合酶链反应(qRT-PCR)法检测miR-217表达水平,酶联免疫吸附试验(ELISA)法对DKK1水平进行检测。采用Logistic回归对影响GDM患者发生不良妊娠结局的独立危险因素进行分析,采用受试者工作特征(ROC)曲线分析miR-217、DKK1水平对GDM患者发生不良妊娠结局的诊断价值。结果GDM组血清miR-217、DKK1水平均高于对照组(P<0.001)。GDM组发生妊娠不良结局的比例显著高于对照组(P<0.05)。与妊娠结局良好组相比,妊娠结局不良组miR-217、DKK1、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、甘油三酯(TG)、空腹血糖、空腹胰岛素及糖化血红蛋白(HbAlc)水平均升高(P<0.05)。血清miR-217、DKK1是影响GDM患者发生不良妊娠结局的独立危险因素(P<0.05)。血清miR-217、DKK1及联合诊断GDM不良妊娠结局的ROC曲线下面积(AUC)分别为0.841、0.849、0.943,miR-217、DKK1联合诊断效能高于单独检测效能(P=0.027)。结论血清miR-217、DKK1水平的升高与GDM不良妊娠结局有关,且miR-217、DKK1及二者联合对GDM患者发生不良妊娠结局均具有预测价值。

Objective To investigate the relationship between serum levels of microRNA-217(miR-217),secretory protein Dickkopf-l(DKK1)and pregnancy outcomes in pregnant patients with gestational diabetes mellitus(GDM)and their predictive value.Methods A total of 97 women with GDM who underwent periodic prenatal examinations and gave birth in Dalian Women′s and Children′s Medical Center from April 2021 to April 2023 were regarded as the GDM group,and 91 healthy pregnant women who underwent health examinations were regarded as the control group.Real-time fluorescence quantitative polymerase chain reaction(qRT-PCR)method was applied to detect the expression level of miR-217,enzyme linked immunosorbent assay(ELISA)was applied to detect DKK1 level.Logistic regression method was applied to analyze independent risk factors affecting the occurrence of adverse pregnancy outcomes in GDM patients.Receiver operating characteristic(ROC)curve was applied to analyze the diagnostic value of miR-217 and DKK1 levels for adverse pregnancy outcomes in GDM patients.Results The serum levels of miR-217 and DKK1 in the GDM group were higher than those in the control group(P<0.001).The proportion of adverse pregnancy outcomes in the GDM group was higher than that in the control group(P<0.05).Compared with the good-pregnancy outcome group,the levels of miR-217,DKK1,low-density lipoprotein cholesterol(LDL-C),total cholesterol(TC),triacylglycerol(TG),fasting blood glucose,fasting insulin,and hemo-globin Alc(HbAlc)in the adverse-pregnancy outcome group were increased(P<0.05).MiR-217 and DKK1 were independent risk factors for adverse pregnancy outcomes in GDM patients(P<0.05).The area under the ROC curve(AUC)of serum miR-217,DKK1,and combination in the diagnosis of adverse pregnancy outcomes in GDM was 0.841,0.849,and 0.943,respectively,the combined diagnostic efficacy of miR-217 and DKK1 was higher than the individual detection efficacy(P=0.027).Conclusions The increase in serum miR-217 and DKK1 levels is associated with adverse pregnancy outcomes in GDM,and miR-217,DKK1,and the combination of both have predictive value for adverse pregnancy outcomes in GDM patients.