妊娠期糖尿病患者血清胱抑素⁃C、CTRP5、CTRP9与HbA1c的相关性及对围产儿不良结局的预测价值

Correlation between Serum Cystatin⁃C,CTRP5,CTRP9 and HbA1c in Patients with Gestational Diabetes Mellitus and Its Predictive Value for Ad⁃verse Perinatal Outcomes

目的探讨妊娠期糖尿病(GDM)患者血清胱抑素-C、补体C1q/肿瘤坏死因子相关蛋白5(CTRP5)、补体C1q/肿瘤坏死因子相关蛋白9(CTRP9)与糖化血红蛋白(HbA1c)的相关性及预测围产儿不良结局的价值。方法选取2022年1月至2023年12月150例GDM患者为研究对象,根据围产儿结局分为不良结局组(n=41)、良好结局组(n=109)。比较2组基线资料及血清胱抑素-C、CTRP5、CTRP9、HbA1c水平,多因素Logistic回归分析GDM患者围产儿不良结局影响因素,Pearson法分析胱抑素-C、CTRP5、CTRP9与HbA1c的相关性,受试者工作特征曲线分析各指标对不良结局的预测价值,并比较各预测方案效能。结果不良结局组年龄、孕前体质量指数(BMI)、分娩前BMI、孕中期口服葡萄糖耐量试验结果及血清胱抑素-C、CTRP5、CTRP9、HbA1c水平与良好结局组比较有差异(P<0.05)。校正其他相关因素后,血清胱抑素-C、CTRP5、CTRP9、HbA1c仍是GDM患者围产儿不良结局的影响因素(P<0.05)。GDM患者血清胱抑素-C、CTRP5与HbA1c呈正相关,CTRP9与HbA1c呈负相关(P<0.05)。血清胱抑素-C、CTRP5、CTRP9联合预测GDM患者围产儿不良结局的曲线下面积为0.936(95%CI:0.885,0.970),优于各指标单独及两两组合预测价值。结论胱抑素-C、CTRP5在GDM患者血清中表达上调,CTRP9表达下调,各指标与HbA1c具有相关性,三者联合检测对围产儿不良结局具有一定预测价值,可作为临床评估血糖控制情况、预测围产儿结局的辅助指标。

Objective To investigate the correlation between serum cystatin-C(CysC),complement C1q/tumor nec-rosis factor-related protein 5(CTRP5),complement C1q/tumor necrosis factor-related protein 9(CTRP9)and glycosylated hemoglobin(HbA1c)in patients with gestational diabetes mellitus(GDM),and their predictive value for adverse perinatal outcomes.Methods A total of 150 patients with GDM from January 2022 to December 2023 were selected as the research subjects and divided into adverse outcome group(n=41)and good outcome group(n=109)according to the perinatal out-comes.The baseline data and serum CysC,CTRP5,CTRP9,and HbA1c levels of the two groups were compared.Multivari-ate logistic regression analysis was used to analyze the influencing factors of adverse perinatal outcomes in GDM patients.Pear-son correlation analysis was used to analyze the correlation between CysC,CTRP5,CTRP9,and HbA1c.Receiver operating characteristic curve analysis was used to analyze the predictive value of each index for adverse outcomes,and the performance of each prediction scheme was compared.Results The differences in age,pre-pregnancy body mass index(BMI),pre-delivery BMI,mid-pregnancy oral glucose tolerance test results,and serum CysC,CTRP5,CTRP9,and HbA1c levels be-tween the adverse outcome group and the good outcome group were statistically significant(P<0.05).After adjusting for oth-er relevant factors,serum CysC,CTRP5,CTRP9,and HbA1c remained as influencing factors for adverse perinatal outcomes in patients with GDM(P<0.05).Serum CysC and CTRP5 were positively correlated with HbA1c in GDM patients,while CTRP9 was negatively correlated with HbA1c(P<0.05).The area under the curve of serum CysC,CTRP5,and CTRP9 in combination for the prediction of adverse perinatal outcomes in GDM patients was 0.936(95%CI:0.885,0.970),which was superior to the predictive value of each individual indicator and the combination of two indicators.Conclusion CysC and CTRP5 expression are upregulated in the serum of GDM patients,while CTRP9 expression is downregulated;each indicator is correlated with HbA1c.Combined detection of the three indicators has certain predictive value for adverse perinatal outcomes and can be used as an auxiliary indicator for clinical evaluation of glycemic control and prediction of perinatal outcomes.