孕早期血清MMP-1、PTEN检测预测妊娠期糖尿病孕妇孕中晚期骨质疏松症的价值研究

Value of MMP-1 and PTEN detection in early pregnancy in predicting osteoporosis in middle and late pregnancy of pregnant women with gestational diabetes mellitus

目的探究孕早期血清基质金属蛋白酶-1(matrix metalloproteinase-1,MMP-1)、第10号染色体缺失性磷酸酶-张力蛋白同源物基因(phosphatase and tensin hmmlogydeleted on ten,PTEN)检测预测妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇孕中晚期骨质疏松症(osteoporosis,OP)的价值。方法回顾性收集2019年9月至2023年2月临沂市人民医院收治的218例GDM孕妇的临床资料,将其纳入GDM组;另选取同期体检的健康妊娠女性98例作为对照组。比较两组年龄、身体质量指数(body mass index,BMI)、血糖相关指标及血清MMP-1、PTEN水平。并根据孕中晚期骨质疏松症发生情况将GDM组患者分为OP组和非OP组。应用Logistic回归分析探究GDM孕妇孕中晚期OP发生的影响因素;绘制ROC曲线分析血清MMP-1、PTEN水平对GDM孕妇孕中晚期发生骨质疏松的预测价值。结果GDM组BMI、空腹血糖、糖化血红蛋白及血清MMP-1、PTEN水平均高于对照组,BUA、SOS、SI等骨密度测定结果低于对照组(t=6.18、12.68、9.91、11.42、7.70、5.63、5.76、9.84,P均<0.05)。218例GDM孕妇中有29例发生OP,189例患者未出现OP。两组空腹血糖、糖化血红蛋白、血钙、血镁、血磷等资料比较,差异无统计学意义(统计值:0.96、0.86、1.35、1.06、0.49,P>0.05)。Logistic回归分析结果显示,年龄、MMP-1、PTEN水平异常升高是GDM孕妇孕中晚期发生OP的独立危险因素[OR(95%CI)=1.260(1.103~1.440)、1.075(1.031~1.120)、1.055(1.023~1.089),P均<0.05]。ROC曲线显示,MMP-1、PTEN指标预测GDM孕妇孕中晚期发生OP的AUC分别为0.824、0.777。二者联合预测GDM孕妇孕中晚期发生OP的AUC为0.933,特异度及敏感度分别为83.04%、93.48%,均高于单独检测。结论孕早期血清MMP-1、PTEN检测在GDM孕妇孕中晚期OP的预测中发挥潜在优势,密切监测二者水平变化,为OP高风险患者的临床诊治提供新思路。

ObjectiveTo explore the value of serum matrix metalloproteinase-1(matrix metalloproteinase-1),and phosphatase and tensin hmmlogydeleted on ten(PTEN),in predicting osteoporosis(OP)in women with gestational diabetes mellitus(GDM).MethodsThe clinical data of.218 pregnant women with GDM treated in Linyi People’s Hospital from Sep.2019 to Feb.2023 were retrospectively collected and included in the GDM group.Another 98 healthy pregnant women who underwent physical examination during the same period were selected as the control group.Age,body mass index(BMI),blood glucose related indexes and serum MMP-1 and PTEN levels were compared between the two groups.According to the occurrence of osteoporosis(OP)in the second and third trimester of pregnancy,the GDM group was divided into OP group and non-OP group.Logistic regression analysis was used to explore the influencing factors of OP in pregnant women with GDM in the second and third trimesters.ROC curve was drawn to analyze the predictive value of serum MMP-1 and PTEN levels for osteoporosis in GDM pregnant women in the second and third trimesters.ResultsBody mass index(BMI),fasting blood glucose(FBG),glycated hemoglobin A1c(HbA1c)and serum MMP-1 and PTEN levels in GDM group were higher than those in control group,but BUA,SOS and SI were lower than those in control group(t=6.18,12.68,9.91,11.42,7.70,5.63,5.76,9.84,all P<0.05).Among 218 GDM women,29 cases had OP and 189 cases did not have OP.There were no significant differences in fasting blood glucose,glycosylated hemoglobin,blood calcium,blood magnesium,or blood phosphorus between the two groups(statistical value:0.96,0.86,1.35,1.06,0.49,P>0.05).Logistic regression analysis showed that age,abnormal increase of MMP-1 and PTEN levels were independent risk factors for OP in GDM women in the second and third trimesters[OR(95%CI)=1.260(1.103-1.440),1.075(1.031-1.120),1.055(1.023-1.089),all P<0.05].ROC curve showed that the AUC of MMP-1 and PTEN in predicting OP in GDM pregnant women in the second and third trimesters were 0.824 and 0.777,respectively.The AUC of the combination of the two in predicting OP in GDM pregnant women in the second and third trimesters was 0.933,and the specificity and sensitivity were 83.04%and 93.48%,respectively,which were higher than those of single detection.ConclusionsMMP-1 and PTEN in early pregnancy may play a potential role in the prediction of OP in pregnant women with GDM.Close monitoring of MMP-1 and PTEN levels may provide new ideas for the clinical diagnosis and treatment of OP high-risk patients.