妊娠期糖尿病孕妇血清淀粉样蛋白A同型半胱氨酸中性粒细胞/淋巴细胞比值游离脂肪酸水平变化及与糖脂代谢和妊娠结局的关系分析

Analysis on the relationships between changes of serum amyloid A,homocysteine,neutrophil/lymphocyte ratio,and free fatty acid levels and glucolipid metabolism,pregnancy outcome in pregnant women with gestational diabetes mellitus

目的分析妊娠期糖尿病(GDM)孕妇血清淀粉样蛋白A(SAA)、同型半胱氨酸(Hcy)、中性粒细胞/淋巴细胞比值(NLR)、游离脂肪酸水平变化及与糖脂代谢和妊娠结局的关系。方法收集2020年3月—2022年11月在义乌市中心医院就诊的GDM孕妇90例为GDM组,同期在义乌市中心医院建档产检并分娩的健康孕妇50例为糖耐量正常组。检测并比较GDM组和糖耐量正常组SAA、Hcy、NLR及游离脂肪酸水平。将GDM组患者分为血糖控制良好(糖化血红蛋白≤6.0%)、血糖控制不良(糖化血红蛋白>6.0%),记录妊娠结局。结果GDM组SAA、Hcy、NLR及游离脂肪酸水平分别为(9.39±0.96)mg/L、(15.68±2.13)μmol/L、(5.42±0.81)、(0.75±0.06)mmol/L,明显高于糖耐量正常组(均P<0.05)。血糖控制不良的GDM孕妇SAA、Hcy、NLR及游离脂肪酸水平分别为(12.00±1.23)mg/L、(19.78±2.49)μmol/L、(7.80±0.98)、(1.02±0.08)mmol/L,明显高于血糖控制良好的GDM孕妇(均P<0.05)。妊娠结局不良的GDM孕妇孕前体质量指数、空腹血糖、空腹胰岛素、糖化血红蛋白分别为(28.08±1.97)kg/m^(2)、(9.51±0.96)mmol/L、(15.63±2.21)m U/L、(8.23±1.06)%,明显高于妊娠结局良好的GDM孕妇(均P<0.05)。妊娠结局不良的GDM孕妇SAA、Hcy、NLR及游离脂肪酸水平分别为(13.75±1.94)mg/L、(24.13±2.78)μmol/L、(10.17±1.14)、(1.27±0.13)mmol/L,明显高于妊娠结局良好的GDM孕妇(均P<0.05)。多因素logistic回归分析显示:糖化血红蛋白、SAA、Hcy、NLR、游离脂肪酸是GDM孕妇不良妊娠结局的独立影响因素(均P<0.05)。SAA、Hcy、NLR、游离脂肪酸对GDM孕妇妊娠结局均具有较高的预测价值(均P<0.05),其中各指标联合检测的预测价值最高,曲线下面积为0.958。结论GDM孕妇SAA、Hcy、NLR及游离脂肪酸水平升高,且与妊娠结局密切相关,联合检测可用于预测GDM的妊娠结局。

Objective To analyze the relationships between changes of serum amyloid A(SAA),homocysteine(Hcy),neutrophil/lymphocyte ratio(NLR),and free fatty acid levels and glucolipid metabolism,pregnancy outcome in pregnant women with gestational diabetes mellitus(GDM).Methods From March 2020 to November 2022,90 pregnant women with GDM treated in Yiwu Central Hospital were selected as GDM group,50 healthy pregnant women establishing medical records,receiving prenatal examination,and giving birth to their babies in Yiwu Central Hospital were selected as normal glucose tolerance group.The levels of SAA,Hcy,NLR,and free fatty acid in GDM group and normal glucose tolerance group were detected and compared.The patients in GDM group were divided into good glucose control(glycosylated hemoglobin≤6.0%)and poor glucose control(glycosylated hemoglobin>6.0%),the pregnancy outcomes were recorded.Results The levels of SAA,Hcy,NLR,and free fatty acid in GDM group were(9.39±0.96)mg/L,(15.68±2.13)μmol/L,(5.42±0.81),and(0.75±0.06)mmol/L,respectively,which were statistically significantly higher than those in normal glucose tolerance group(P<0.05).The levels of SAA,Hcy,NLR,and free faty acid in poor glucose control GDM pregnant women were(12.00±1.23)mg/L,(19.78±2.49)μmol/L,(7.80±0.98),and(1.02±0.08)mmo/L,respectively,which were statistically significantly higher than those in good glucose control GDM pregnant women(P<0.05).Pre-pregnancy body mass index,fasting blood glucose,fasting insulin,and glycosylated hemoglobin in GDM pregnant women with poor pregnancy outcome were(28.08±1.97)kg/m^(2),(9.51±0.96)mmol/L,(15.63±2.21)mU/L,and(8.23±1.06)%,which were statistically significantly higher than those in GDM pregnant women with good pregnancy outcome(P<0.05).The levels of SAA,Hcy,NLR,and free fatty acid in GDM pregnant women with poor pregnancy outcomewere(13.75±1.94)mg/L,(24.13±2.78)μmol/L,(10.17±1.14),and(1.27±0.13)mmol/L, whichwere statistically significantly higher than those in GDM pregnant women with good pregnancy outcome (P<0. 05) . Multivariate logistic regression analysis showed that glycosylated hemoglobin, SAA, Hcy,NLR, and free fatty acid were independent influencing factors of poor pregnancy outcome in GDM pregnant women (P<0. 05) . SAA, Hcy,NLR, and free fatty acid had high predictive value for pregnancy outcome in CDM pregnant women (P<0. 05), the predictive value of jointdetection was the highest, the area under ROC curve was 0. 958. Conclusion The levels of SAA, Hcy, NLR, and free fatty acid in GDMpregnant women increased, which are closely correlated with pregnancy outcome, joint detection can predict pregnancy outcome of GDMpregnant women.