妊娠期糖尿病患者PAPPA水平、HbA1c与胰岛素抵抗及妊娠结局的关系分析

Analysis of the relationship between PAPPA level,HbA1c with insulin resistance and pregnancy outcome in patients with gestational diabetes mellitus

目的分析妊娠期糖尿病(GDM)患者妊娠相关血浆蛋白A(PAPPA)水平、糖化血红蛋白(HbA1c)与胰岛素抵抗及妊娠结局的关系。方法选取2021年9月至2022年6月我院接收的95例GDM患者纳入观察组,同期来院产检的95例孕妇纳入对照组。比较两组研究对象的一般资料、不良妊娠结局发生情况;比较不同胰岛素抵抗分级及不同妊娠结局患者的PAPPA水平及HbA1c。结果观察组的身体质量指数(BMI)、空腹血糖(FBG)、餐后2 h血糖(2 h PG)、HbA1c、空腹胰岛素(FINS)水平及胰岛素抵抗指数(HOMA-IR)高于对照组,PAPPA水平低于对照组(P<0.05)。观察组的不良妊娠结局总发生率明显高于对照组(P<0.05)。胰岛素抵抗分级Ⅰ级患者的PAPPA水平高于Ⅱ、Ⅲ级,HbA1c低于Ⅱ、Ⅲ级;Ⅱ级患者的PAPPA水平高于Ⅲ级,HbA1c低于Ⅲ级(P<0.05)。不良妊娠结局患者的PAPPA水平低于正常妊娠结局者,HbA1c高于正常妊娠结局者(P<0.05)。结论GDM患者的PAPPA水平、HbA1c与胰岛素抵抗及妊娠结局相关,低PAPPA水平、高HbA1c可增加高胰岛素抵抗及不良妊娠结局发生风险。

Objective To analyze the relationship between pregnancy-associated plasma protein A(PAPPA)level,glycosylated hemoglobin(HbA1c)with insulin resistance and pregnancy outcome in patients with gestational diabetes mellitus(GDM).Methods A total of 95 GDM patients received in our hospital from September 2021 to June 2022 were included in observation group,and 95 pregnant women who came to our hospital for prenatal examination during the same period were included in control group.The general data and adverse pregnancy outcomes of the two groups were compared;the levels of PAPPA and HbA1c in patients with different insulin resistance grades and different pregnancy outcomes were compared.Results The body mass index(BMI),fasting blood glucose(FBG),2 h postprandial blood glucose(2 h PG),HbA1c,fasting insulin(FINS)levels and homeostasis model assessment insulin resistance index(HOMA-IR)in the observation group were higher than those in the control group,and the PAPPA level was lower than that in the control group(P<0.05).The total incidence of adverse pregnancy outcomes in the observation group was significantly higher than that in the control group(P<0.05).The PAPPA level of patients with insulin resistance gradeⅠwas higher than that of gradeⅡandⅢ,and HbA1c was lower than that of gradeⅡandⅢ;the PAPPA level of patients with gradeⅡwas higher than that of gradeⅢ,HbA1c was lower than that of gradeⅢ(P<0.05).The PAPPA level in patients with adverse pregnancy outcomes was lower than that in patients with normal pregnancy outcomes,and HbA1c was higher than that in patients with normal pregnancy outcomes(P<0.05).Conclusion The PAPPA level and HbA1c in GDM patients are associated with insulin resistance and pregnancy outcomes.Low PAPPA level and high HbA1c can increase the risk of high insulin resistance and adverse pregnancy outcomes.