妊娠期糖尿病患者血清微小RNA-875-5p与血清硫氧还蛋白还原酶1对母婴结局的预测价值

Predictive value of serum microRNA⁃875⁃5p and serum thioredoxin reductase 1 in gestational diabetes mellitus for maternal and infant outcomes

目的探讨妊娠期糖尿病(GDM)患者血清硫氧还蛋白还原酶1(TXNRD1)、微小RNA-875-5p(miR-875-5p)对母婴结局的预测价值。方法选择2019年4月~2020年4月本院收治的GDM患者124例作为GDM组,另选本院同期体检的健康妊娠女性124例作为对照组。根据母体结局与围生儿结局将GDM组患者分别分为母体结局不良组(46例)、母体结局良好组(78例)及围生儿结局不良组(49例)、围生儿结局良好组(75例)。收集所有受试者一般临床资料,血清中TXNRD1、miR-875-5p相对表达水平、母体及围生儿不良结局并分组进行比较。采用多因素logistic回归分析评估GDM患者母婴不良结局的影响因素;采用受试者工作特征(ROC)曲线分析miR-875-5p和TXNRD1对母婴不良结局的预测价值。结果GDM组患者血清miR-875-5p相对表达水平显著低于对照组,血清TXNRD1相对表达水平显著高于对照组(P<0.05);GDM组母体不良结局中羊水过多、胎膜早破、早产、剖宫产、产后出血比例及母体不良结局总发生率均显著高于对照组,围生儿不良结局中巨大儿、胎儿窘迫、新生儿窒息、新生儿低血糖、高胆红素血症比率及围生儿不良结局总发生率均显著高于对照组(P<0.05)。多因素logistic回归分析结果显示,血清miR-875-5p均是GDM患者母体、围生儿不良结局的保护因素,年龄、孕前BMI、不良孕产史、血糖控制不良及血清TXNRD1均是其危险因素(P<0.05)。ROC曲线分析结果显示,血清miR-875-5p、TXNRD1对母体、围生儿不良结局联合预测的AUC均大于二者单独预测。结论血清miR-875-5p、TXNRD1在GDM患者中分别为异常低、高表达,并均对母婴结局具有一定预测价值,且二者联合预测价值更高。

Objective To investigate the expression levels of serum thioredoxin reductase 1(TXNRD1),microRNA⁃875⁃5p(miR⁃875⁃5p),and their predictive value for maternal and infant outcomes in patients with gestational diabetes mellitus(GDM).Methods A total of 124 cases of GDM patients admitted to our hospital from April 2019 to April 2020 were selected as GDM group,and another 124 cases of healthy pregnant women with normal physical examination in the same period were selected as control group.The patients in GDM group were divided into poor maternal outcome group(46 cases),good maternal outcome group(78 cases)and poor perinatal outcome group(49 cases)and good perinatal outcome group(75 cases)based on maternal outcome and perinatal outcome,respectively.General clinical data,serum TXNRD1,miR⁃875⁃5p phase,maternal and perinatal poor outcome were collected and grouped for comparison.Multifactorial logistic regression analysis was used to assess the influencing factors of maternal and infant adverse outcomes in GDM patients;subjects’work characteristics(ROC)curves were used to analyze miR⁃875⁃5p and TXNRD1 predictive value for maternal and infant adverse outcomes.Results The rates of preterm labor,cesarean section,postpartum hemorrhage,and total adverse maternal outcomes were significantly higher in GDM group than in control group,and the rates of macrosomia,fetal distress,neonatal asphyxia,neonatal hypoglycemia,hyperbilirubinemia,and total adverse perinatal outcomes were significantly higher in GDM group than in control group(P<0.05).Multifactorial logistic regression analysis showed that serum miR⁃875⁃5p were all protective factors for maternal and perinatal adverse outcomes in GDM patients,and age,pre⁃pregnancy BMI,poor maternal history,poor glycemic control and serum TXNRD1 were all risk factors(P<0.05).The ROC curve results showed that the AUC of serum miR⁃875⁃5p and TXNRD1 for the combined prediction of maternal and perinatal adverse outcomes was greater than both of them individually predicted.Conclusion Serum miR⁃875⁃5p and TXNRD1 were abnormally low and high expressed in GDM patients,respectively,and both had some predictive value for maternal and infant outcomes,and the combined predictive value of the two was higher.