妊娠糖尿病孕妇血清谷胱甘肽过氧化物酶3、水通道蛋白9表达水平及意义

Expression levels and significance of serum glutathione peroxidase 3 and aquaporin 9 in pregnant women with gestational diabetes mellitus

目的探讨妊娠糖尿病(GDM)孕妇血清谷胱甘肽过氧化物酶3(GPX3)、水通道蛋白9(AQP9)表达水平变化及其与妊娠结局的关系。方法选取200例GDM孕妇(GDM组)和200名健康孕妇(对照组)作为研究对象,并根据妊娠结局将GDM组孕妇进一步分为不良妊娠结局(APO)亚组22例和良好妊娠结局亚组178例,采用酶联免疫吸附法检测血清GPX3、AQP9表达水平。采用多因素Logistic回归分析法筛选GDM孕妇APO的影响因素;绘制受试者工作特征(ROC)曲线,分析血清GPX3、AQP9表达水平对GDM孕妇APO的预测效能。结果与对照组比较,GDM组血清GPX3表达水平降低,血清AQP9表达水平升高,差异有统计学意义(P<0.05)。200例GDM孕妇的APO发生率为11.00%(22/200)。与良好妊娠结局亚组比较,APO亚组稳态模型评估-胰岛素抵抗指数(HOMA-IR)、空腹血糖、糖化血红蛋白(HbA1c)和AQP9水平更高,GPX3水平更低,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,HOMA-IR、HbA1c、AQP9升高为GDM孕妇APO的独立危险因素(P<0.05),GPX3升高为GDM孕妇APO的独立保护因素(P<0.05)。ROC曲线显示,血清GPX3、AQP9单独和联合预测GDM孕妇APO的曲线下面积为0.784(95%CI:0.673~0.881)、0.788(95%CI:0.687~0.894)和0.906(95%CI:0.805~0.972),两者联合预测的曲线下面积大于单独预测(P<0.05)。结论GDM孕妇血清GPX3表达水平降低,血清AQP9表达水平升高,血清GPX3、AQP9均为APO的独立影响因素,两者联合预测GDM孕妇APO的价值较高。

Objective To investigate the changes in the expression levels of serum glutathione peroxidase 3(GPX3)and aquaporin 9(AQP9)in pregnant women with gestational diabetes mellitus(GDM)and their relationships with pregnancy outcomes.Methods A total of 200 pregnant women with GDM(GDM group)and 200 healthy pregnant women(control group)were enrolled as study subjects.The GDM group was further divided into adverse pregnancy outcome(APO)subgroup(n=22)and favorable pregnancy outcome subgroup(n=178)based on pregnancy outcomes.The expression levels of serum GPX3 and AQP9 were detected by enzyme-linked immunosorbent assay.Multivariate Logistic regression analysis was used to screen for influencing factors of APO in GDM pregnant women.Receiver operating characteristic(ROC)curves were plotted to analyze the predictive performance of serum GPX3 and AQP9 expression levels for APO in GDM pregnant women.Results Compared with the control group,the serum GPX3 expression level was decreased,and the serum AQP9 expression level was increased in the GDM group(P<0.05).The incidence of APO among the 200 GDM pregnant women was 11.00%(22/200).Compared with the favorable pregnancy outcome subgroup,the APO group had higher levels of homeostasis model assessment-insulin resistance index(HOMA-IR),fasting blood glucose,glycated hemoglobin(HbA1c),and AQP9,and lower levels of GPX3(P<0.05).Multivariate Logistic regression analysis revealed that elevated HOMA-IR,HbA1c,and AQP9 were independent risk factors for APO in GDM pregnant women(P<0.05),while elevated GPX3 was an independent protective factor(P<0.05).The ROC curve showed that the areas under the curve(AUCs)for predicting APO in GDM pregnant women were 0.784(95%CI,0.673 to 0.881)for serum GPX3 alone,0.788(95%CI,0.687 to 0.894)for serum AQP9 alone,and 0.906(95%CI,0.805 to 0.972)for their combination,with the AUC for the combined prediction being greater than that for individual prediction(P<0.05).Conclusion The serum GPX3 expression level is decreased,and the serum AQP9 expression level is increased in GDM pregnant women.Both serum GPX3 and AQP9 are independent influencing factors for APO,and their combined prediction has a higher value for APO in GDM pregnant women.