GDM孕妇血清25(OH)D、IGF-1水平及预测新生儿NHB价值

Levels of the serum25 hydroxyvitamin D and the insulin growth factor-1 of women with gestational diabetes mellitus and their predictive values for the neonatal hyperbilirubinemia

目的:探讨妊娠期糖尿病(GDM)孕妇血清25羟基维生素D[25(OH)D]、胰岛素生长因子-1(IGF-1)水平预测新生儿高胆红素血症(NHB)价值。方法:选取2023年1月-2024年3月本院收治的290例GDM孕妇临床资料为病例组,根据是否发生NHB分为NHB组(n=88)和非NHB组(n=202),同期分娩的健康孕妇266例临床资料为对照组,logistic回归分析NHB影响因素,受试者工作特征(ROC)曲线分析血清25(OH)D、IGF-1预测NHB的价值,Spearman法分析GDM孕妇血清25(OH)D、IGF-1水平与NHB发生的相关性。结果:病例组血清25(OH)D(29.64±3.16 ng/ml)、IGF-1(38.86±4.17 ng/ml)水平均低于对照组(34.71±3.82 ng/ml、45.58±4.69 ng/ml),且病例组新生儿NHB组血清25(OH)D(27.54±2.86 ng/ml)、IGF-1(35.68±3.81 ng/ml)水平均低于非NHB组(30.55±3.29 ng/ml、40.25±4.33 ng/ml)(均P<0.05)。产前空腹血糖高、家族糖尿病史、Apgar 5min评分低、血清25(OH)D及IGF-1水平低为GDM孕妇发生NHB的危险因素(P<0.05)。25(OH)D及IGF-1联合预测NHB发生的曲线下面积(0.878)高于25(OH)D、IGF-1单独预测(0.784、0.775)(P<0.001),GDM孕妇血清25(OH)D、IGF-1水平与NHB发生均呈负相关(r=-0.409、-0.421,P<0.05)。结论:GDM孕妇血清25(OH)D、IGF-1水平降低,对其新生儿发生NHB有一定评估价值。

Objective:To investigate the predictive values of the levels of the serum 25hydroxyvitamin D[25(OH)D]and the insulin growth factor-1(IGF-1)of pregnant women with gestational diabetes mellitus(GDM),and to study the predictive values of the levels of the serum 25(OH)D and IGF-1 of the women for their neonatal hyperbilirubinemia(NHB).Methods:From January 2023to March 2024,290pregnant women with GDM were selected in study group and were divided into group A(88cases with NHB)and group B(202cases without NHB)according to whether NHB occurred.266healthy pregnant women who gave birth during the same period were selected in control group.Logistic regression was applied to analyze the influencing factors of the NHB occurrence.Receiver operating characteristic(ROC)curve was used to analyze the predictive values of the serum 25(OH)D and IGF-1 levels of the women with GDM for their NHB occurrence.Spearman method was applied to analyze the correlation between the serum 25(OH)D and IGF-1 levels of the women with GDM and their NHB occurrence.Results:The serum levels of 25(OH)D(29.64±3.16ng/ml)and IGF-1(38.86±4.17ng/ml)of the women in the study group were significantly lower than those(34.71±3.82ng/ml and 45.58±4.69ng/ml)of the women in the control group.In the study group,the serum levels of 25(OH)D(27.54±2.86ng/ml)and IGF-1(35.68±3.81ng/ml)of the women in group A were significantly lower than those(30.55±3.29ng/ml and 40.25±4.33ng/ml)of the women in group B(all P<0.05).The high prenatal fasting blood glucose value,the family history of diabetes,the low neonatal Apgar score at 5min after birth,and the low serum 25(OH)D and IGF-1levels of the women with GDM were the risk factors of their NHB occurrence(P<0.05).The area under the curve(AUC)of the combination of the 25(OH)D and IGF-1levels of the women with GDM for predicting their NHB occurrence was 0.878,and which was significantly higher than that(0.784)of the 25(OH)D level or that(0.775)of IGF-1 level alone(P<0.001).The serum levels of 25(OH)D and IGF-1 of the women with GDM were negatively correlated with their NHB occurrence(r=-0.409,-0.421,P<0.05).Conclusion:The serum levels of 25(OH)D and IGF-1 of the women with GDM decrease,and which have certain values for evaluating the NHB occurrence of the women.