妊娠期糖尿病患者血清BCAAs、SFRP5水平与产后糖代谢异常的关系

Relationships of serum BCAAs and SFRP5 levels with postnatal abnormal glucose metabolism in patients with gestational diabetes mellitus

目的探讨妊娠期糖尿病(GDM)患者血清支链氨基酸(BCAAs)、分泌型卷曲相关蛋白5(SFRP5)水平与产后糖代谢异常(AGM)的关系。方法选取GDM患者204例作为GDM组,同期于本院分娩的健康孕妇102例作为对照组,根据产后3个月是否发生AGM将GDM患者分为AGM组和非AGM组。采用氨基酸分析仪测定血清BCAAs(缬氨酸、异亮氨酸、亮氨酸)水平,酶联免疫吸附法检测血清SFRP5水平。以产后AGM为因变量,建立多因素非条件Logistic回归模型确定GDM患者产后AGM的因素,并绘制受试者工作特征曲线,评价血清BCAAs、SFRP5水平对产后AGM的预测价值。结果与对照组比较,GDM组血清缬氨酸、异亮氨酸、亮氨酸、BCAAs水平升高,SFRP5水平降低(P均<0.05)。随访3个月,204例GDM患者产后AGM发生率为31.86%(65/204)。与非AGM组比较,AGM组血清缬氨酸、异亮氨酸、亮氨酸、BCAAs水平升高,SFRP5水平降低(P均<0.05)。糖尿病家族史、OGTT餐后2 h血糖水平升高、BCAAs水平升高为GDM患者产后AGM的独立危险因素,SFRP5水平升高为独立保护因素(P均<0.05)。血清BCAAs联合SFRP5水平预测GDM患者产后AGM的曲线下面积为0.861,大于血清BCAAs、SFRP5水平单独预测的0.783、0.787(P均<0.05)。结论GDM患者血清BCAAs水平升高,SFRP5水平降低,与产后AGM独立相关,血清BCAAs联合SFRP5水平对产后AGM有较高预测价值。

Objective To investigate the relationships between serum branched chain amino acids(BCAAs)and secreted frizzled-related protein 5(SFRP5)levels and postnatal abnormal glucose metabolism(AGM)in patients with gestational diabetes mellitus(GDM).Methods Totally 204 patients with GDM were selected as the GDM group and 102 healthy pregnant women who delivered in our hospital in the same time period were selected as the control group,and the patients with GDM were divided into the AGM group and the non-AGM group according to the occurrence of AGM in the first three months after delivery.Serum BCAAs(valine,isoleucine,leucine)levels were measured by amino acid analyzer assay and serum SFRP5 level was measured by enzyme-linked immunosorbent assay.A multifactorial unconditional Logistic regression model was established to determine the factors of postnatal AGM in GDM patients with postnatal AGM as the dependent variable,and receiver operating characteristic(ROC)curves were plotted to evaluate the predictive value of serum BCAAs and SFRP5 levels.Results Compared with the control group,serum valine,isoleucine,leucine,and BCAAs levels increased and SFRP5 level decreased in the GDM group(all P<0.05).At 3-month follow-up,the incidence of postpartum AGM was 31.86%(65/204)in 204 GDM patients.Compared with the non-AGM group,serum valine,isoleucine,leucine,and BCAAs levels increased and SFRP5 level decreased in the AGM group(all P<0.05).Family history of diabetes mellitus,increased OGTT 2 h glucose,and increased BCAAs were independent risk factors for postpartum AGM in GDM patients,and increased SFRP5 was an independent protective factor(all P<0.05).The area under the curve of serum BCAAs combined with SFRP5 level in predicting postpartum AGM in GDM patients was 0.861,which was greater than that(0.783 and 0.787)of serum BCAAs and SFRP5 levels alone(both P<0.05).Conclusion The elevated serum BCAAs level and reduced SFRP5 level in GDM patients were independently associated with postnatal AGM,and serum BCAAs combined with SFRP5 levels had a high predictive value.