血清E-cadherin、IGFBP5在妊娠期糖尿病患者中的水平及其与胰岛素抵抗的关系

Serum levels of E-cadherin and IGFBP5 in patients with gestational diabetes mellitus and their relationship with insulin resistance

目的探讨妊娠期糖尿病患者血清E-钙黏蛋白(E-cadherin)和胰岛素样生长因子结合蛋白5(IGFBP5)水平及其与胰岛素抵抗的关系。方法选取2019年5月至2021年5月该院收治的84例妊娠期糖尿病患者作为观察组,根据胰岛素抵抗指数(HOMA-IR)将观察组分为胰岛素抵抗组(HOMA-IR>2.69)和无胰岛素抵抗组(HOMA-IR≤2.69)。另选取同期在该院进行健康体检的84例健康孕妇作为对照组。采用酶联免疫吸附试验检测所有研究对象血清E-cadherin、IGFBP5水平;采用Pearson相关分析胰岛素抵抗组血清E-cadherin、IGFBP5水平与HOMA-IR的相关性;采用受试者工作特征(ROC)曲线分析血清E-cadherin、IGFBP5对妊娠期糖尿病患者发生胰岛素抵抗的诊断价值。结果观察组血清E-cadherin水平低于对照组,血清IGFBP5水平高于对照组,差异均有统计学意义(P<0.05)。无胰岛素抵抗组年龄、孕产次、孕周、产前体质量指数、收缩压、舒张压、总胆固醇、甘油三酯与胰岛素抵抗组比较,差异均无统计学意义(P>0.05);无胰岛素抵抗组HOMA-IR低于胰岛素抵抗组,差异有统计学意义(P<0.05);胰岛素抵抗组血清E-cadherin水平低于无胰岛素抵抗组,血清IGFBP5水平高于无胰岛素抵抗组,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,胰岛素抵抗组血清E-cadherin水平与HOMA-IR呈负相关(P<0.05),血清IGFBP5水平与HOMA-IR呈正相关(P<0.05)。ROC曲线分析结果显示,血清E-cadherin、IGFBP5诊断妊娠期糖尿病患者发生胰岛素抵抗的曲线下面积(AUC)分别为0.746、0.811,最佳截断值分别为2325.58、27.67 ng/mL,2项联合检测诊断妊娠期糖尿病患者发生胰岛素抵抗的AUC为0.893。结论妊娠期糖尿病患者血清E-cadherin水平降低,IGFBP5水平升高,2项联合检测对妊娠期糖尿病患者发生胰岛素抵抗具有一定临床诊断价值。

Objective To investigate the serum levels of E-cadherin and insulin-like growth factor binding protein 5(IGFBP5)in patients with gestational diabetes mellitus(GDM)and their relationship with insulin resistance.Methods A total of 84 patients with gestational diabetes mellitus admitted to this hospital from May 2019 to May 2021 were selected as the observation group.According to the insulin resistance index(HOMA-IR),the observation group were divided into insulin resistance group(HOMA-IR>2.69)and non-insulin resistance group(HOMA-IR≤2.69).In addition,84 healthy pregnant women who underwent physical examination in the hospital during the same period were selected as the control group.The serum levels of E-cadherin and IGFBP5 in all subjects were detected by enzyme-linked immunosorbent assay.Pearson correlation analysis was used to analyze the correlation between serum E-cadherin,IGFBP5 levels and HOMA-IR in insulin resistance group.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of serum E-cadherin and IGFBP5 for insulin resistance in patients with gestational diabetes mellitus.Results The serum level of E-cadherin in the observation group was lower than that in the control group,and the serum level of IGFBP5 was higher than that in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in age,gravidity,parity,gestational weeks,prenatal body mass index,systolic blood pressure,diastolic blood pressure,total cholesterol,and triglyceride between the non-insulin resistance group and the insulin resistance group(P>0.05).HOMA-IR in non-insulin resistance group was significantly lower than that in insulin resistance group(P<0.05).The level of serum E-cadherin in the insulin resistance group was lower than that in the non-insulin resistance group,and the level of serum IGFBP5 was higher than that in the non-insulin resistance group,and the differences were statistically significant(P<0.05).Pearson correlation analysis showed that serum E-cadherin level was negatively correlated with HOMA-IR in the insulin resistance group(P<0.05),and serum IGFBP5 level was positively correlated with HOMA-IR(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum E-cadherin and IGFBP5 for the diagnosis of insulin resistance in patients with gestational diabetes mellitus was 0.746 and 0.811 respectively,and the best cut-off value was 2325.58 and 27.67 ng/mL respectively.The AUC of combined detection of the two in the diagnosis of insulin resistance in patients with gestational diabetes mellitus was 0.893.Conclusion Serum E-cadherin level is decreased and IGFBP5 level is increased in patients with gestational diabetes mellitus.The combined detection of the two has certain clinical diagnostic value for insulin resistance in patients with gestational diabetes mellitus.