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中华妇幼临床医学杂志(电子版) ›› 2023, Vol. 19 ›› Issue (03) : 302 -308. doi: 10.3877/cma.j.issn.1673-5250.2023.03.009

论著

血清脂联素与胎盘亮氨酸氨肽酶对妊娠期糖尿病患者妊娠结局的影响
冯丹艳, 曹晓辉†(), 史玉霞   
  1. 无锡市妇幼保健院，江南大学附属妇产医院产科，无锡　214000
  • 收稿日期:2022-08-30 修回日期:2023-04-10 出版日期:2023-06-01
  • 通信作者: 曹晓辉

Effect of serum adiponectin and placental leucine aminopeptidase levels on pregnancy outcome in pregnant women with gestational diabetes mellitus

Danyan Feng, Xiaohui Cao†(), Yuxia Shi   

  1. Department of Obstetrics, Wuxi Maternity and Child Health Care Hospital, Women's Hospital of Jiangnan University Wuxi 214000, Jiangsu Province, China
  • Received:2022-08-30 Revised:2023-04-10 Published:2023-06-01
  • Corresponding author: Xiaohui Cao
  • Supported by:
    Maternal and Child Health Research Project of Jiangsu Provincial Health Commission(F201935)
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引用本文：

冯丹艳, 曹晓辉, 史玉霞. 血清脂联素与胎盘亮氨酸氨肽酶对妊娠期糖尿病患者妊娠结局的影响[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(03): 302-308.

Danyan Feng, Xiaohui Cao, Yuxia Shi. Effect of serum adiponectin and placental leucine aminopeptidase levels on pregnancy outcome in pregnant women with gestational diabetes mellitus[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(03): 302-308.

目的

探讨血清脂联素、胎盘亮氨酸氨肽酶(P-LAP)水平，对妊娠期糖尿病(GDM)患者妊娠结局的影响。

方法

选择2019年12月至2022年1月无锡市妇幼保健院，江南大学附属妇产医院收治的143例GDM患者为研究对象。采用回顾性分析方法，根据GDM患者妊娠结局，将其分别纳入良好组(n＝115)与不佳组(n＝28)。对2组患者于孕龄为24孕周时，进行空腹血糖(FBG)，1、2 h 75 g口服葡萄糖耐量试验(OGTT)，糖化血红蛋白(HbA1c)及血清脂联素与P-LAP水平检测，并采用成组t检验进行统计学分析。采用多因素非条件logistic回归分析，对GDM患者妊娠结局影响因素进行分析。采用受试者工作特征(ROC)曲线，分析血清脂联素及P-LAP水平对GDM患者妊娠结局的预测价值。本研究遵循的程序符合无锡市妇幼保健院，江南大学附属妇产医院伦理委员会制定的伦理学标准，并得到该伦理委员会批准(审批文号：2018-003-02)。2组患者年龄、孕前人体质量指数(BMI)、孕次、产次等一般临床资料比较，差异均无统计学意义(P>0.05)。

结果

不佳组GDM患者分娩孕龄与血清脂联素、P-LAP水平，均显著低于良好组，而血糖控制不佳占比与HbA1c水平，则均显著高于良好组，并且差异均有统计学意义(t＝3.89、P<0.001，t＝8.22、P<0.001，t＝2.57、P＝0.025，χ2＝101.54、P<0.001，t＝3.95、P<0.001)。2组患者FPG及1、2 h OGTT血糖浓度等分别比较，差异均无统计学意义(P>0.05)。多因素非条件logistic回归分析结果显示，分娩孕龄及HbA1c水平、血清脂联素与P-LAP水平及血糖控制不佳，均为GDM患者妊娠结局的独立影响因素(OR＝3.307、0.216、3.846、3.099、0.552，95%CI：1.401~7.806、0.091~0.509、1.629~9.079、1.313~7.315、0.416~0.783，P＝0.017、0.014、0.017、0.014、0.025)。ROC曲线分析结果显示，血清脂联素与P-LAP水平单一指标及其联合预测GDM患者妊娠结局的曲线下面积(AUC)分别为0.709(95%CI：0.594~0.825，P＝0.002)，0.706(95%CI：0.584~0.821，P＝0.001)，0.791(95%CI：0.679~0.897，P＝0.003)。

结论

血清脂联素、P-LAP水平降低，均为GDM患者不良妊娠结局的独立影响因素，可用于辅助预测GDM患者妊娠结局。

关键词: 糖尿病，妊娠, 脂联素, 胎盘亮氨酸氨肽酶, 妊娠结局, 孕妇
Objective

To explore the effects of serum adiponectin and placental leucine aminopeptidase (P-LAP) levels on pregnancy outcomes in pregnant women with gestational diabetes mellitus (GDM).

Methods

A total of 143 cases of GDM pregnant women admitted to Wuxi Maternity and Child Health Care Hospital, Women's Hospital of Jiangnan University from December 2019 to January 2022 were selected in the study. According to the pregnancy outcome, pregnant women with GDM were divided into good result group (n=115) and poor result group (n=28) by retrospective analysis method. Fasting blood glucose (FPG) and 1 h, 2 h 75 g oral glucose tolerance test (OGTT), glycosylated hemoglobin (HbA1c), serum adiponectin and P-LAP levels were detected in all pregnant women at 24 week of gestation, and were analyzed by independent-samples t test. The influencing factors of pregnancy outcomes in pregnant women with GDM were analyzed by multivariate unconditional logistic regression. Receiver operating characteristic (ROC) curve was used to analyzed predictive value of serum adiponectin and P-LAP levels for pregnancy outcomes in pregnant women with GDM. The procedures followed in this study were in line with ethical standards set by the Ethics Committee of Wuxi Maternity and Child Health Care Hospital, Women's Hospital of Jiangnan University and were approved by the Ethics Committee (Approval No. 2018-003-02). There were no statistical differences in age, body mass index (BMI), gravidity and parity between two groups (P>0.05).

Results

Gestation age at delivery, serum adiponectin and P-LAP levels in poor group of pregnant women with GDM were significantly lower than those in good result group, while proportion of poor control of blood glucose concentration and HbA1c level were significantly higher than those in good result group, and all differences were statistically significant (t=3.89, P<0.001; t=8.22, P<0.001; t=2.57, P=0.025; χ2=101.54, P<0.001; t=3.95, P<0.001). There were no significant differences in FPG, 1 h and 2 h OGTT blood glucose concentration between two groups (P>0.05). Multivariate unconditional logistic regression analysis showed that gestational age at delivery, HbA1c level, serum adiponectin and P-LAP levels, and poor control of blood glucose concentration were all independent influencing factors for pregnancy outcomes in pregnant women with GDM (OR=3.307, 0.216, 3.846, 3.099, 0.552; 95%CI: 1.401-7.806, 0.091-0.509, 1.629-9.079, 1.313-7.315, 0.416-0.783; P=0.017, 0.014, 0.025). ROC curve analysis results showed that area under curve (AUC) of serum adiponectin and P-LAP levels and their combined prediction of pregnancy outcomes in pregnant women with GDM were 0.709 (95%CI: 0.594-0.825, P=0.002), 0.706 (95%CI: 0.584-0.821, P=0.001), and 0.791 (95%CI: 0.679-0.897, P=0.003), respectively.

Conclusions

The decrease in serum adiponectin and P-LAP levels are both independent influencing factors of adverse pregnancy outcomes in pregnant women with GDM, and can be used to predict pregnancy outcomes in pregnant women with GDM.

Key words: Diabetes, gestational, Adiponectin, Placental leucine aminopeptidase, Pregnancy outcome, Pregnant women
表1 2组GDM患者相关临床资料比较
组别 例数 分娩年龄(岁，±s) 孕前BMI(kg/m2，±s) 分娩孕龄(周，±s) 孕次[例数(%)] 孕次[例数(%)] FPG(mmol/L，±s)) OGTT(mmol/L，±s)
<2次 ≥2次 <2次 ≥2次 1 h 2 h
良好组 115 29.9±4.4 22.1±0.5 39.2±1.3 36(31.3) 79(68.7) 69(60.0) 46(40.0) 7.0±0.8 10.1±1.4 8.6±0.7
不佳组 28 31.6±4.3 22.3±0.5 38.2±1.1 5(17.9) 23(82.1) 17(60.7) 11(39.3) 7.2±0.6 10.2±1.5 8.7±0.9
统计量   t＝1.86 t＝1.01 t＝3.89 χ2＝1.99 χ2＝0.01 t＝1.43 t＝0.33 t＝0.64
P值   0.065 0.316 <0.001 0.158 0.994 0.156 0.739 0.524
组别 例数 HbA1c(%，±s) HDL(mmol/L，±s) LDL(mmol/L，±s) TG(mmol/L，±s) TC(mmol/L，±s) 脂联素(μg/mL，±s) P-LAP(pg/mL，±s) 血糖控制[例数(%)]
不佳 良好
良好组 115 5.4±1.1 1.7±0.3 2.4±0.5 1.6±0.5 5.1±1.0 9.6±0.4 561.4±125.5 3(2.6) 112(97.4)
不佳组 28 6.3±1.0 1.8±0.5 2.2±0.6 1.6±0.6 5.2±1.0 8.9±0.5 494.2±117.3 24(85.7) 4(14.3)
统计量   t＝3.95 t＝0.25 t＝1.35 t＝0.53 t＝0.72 t＝8.22 t＝2.57 χ2＝101.54
P值   <0.001 0.803 0.179 0.597 0.473 <0.001 0.025 <0.001
表2 GDM患者妊娠结局影响因素的多因素非条件logistic回归分析变量含义及赋值情况
自变量/因变量 变量名 赋值
GDM患者妊娠结局 y y＝0表示妊娠结局不佳，y＝1表示妊娠结局良好
分娩孕龄 x1 定量变量
血清脂联素水平 x2 定量变量
血清P-LAP水平 x3 定量变量
HbA1c水平 x4 定量变量
血糖控制情况 x5 x5＝0表示血糖控制良好，x5＝1表示血糖控制不佳
表3 GDM患者妊娠结局影响因素的多因素非条件logistic回归分析结果
影响因素 B SE Wald值 P值 OR值 OR值95%CI
分娩孕龄 1.196 0.601 3.960 0.017 3.307 1.401~7.806
血清脂联素水平 1.347 0.682 3.901 0.017 3.846 1.629~9.079
血清P-LAP水平 1.131 0.504 5.036 0.014 3.099 1.313~7.315
HbA1c水平 －1.534 0.691 4.928 0.014 0.216 0.091~0.509
血糖控制不佳 －0.594 0.247 5.783 0.025 0.552 0.416~0.783
图1 血清脂联素及P-LAP水平预测GDM患者妊娠结局的ROC曲线注：P-LAP为胎盘亮氨酸氨肽酶，GDM为妊娠期糖尿病，ROC曲线为受试者工作特征曲线
表4 血清脂联素与P-LAP水平预测GDM患者妊娠结局的ROC曲线分析结果
指标 ROC曲线 最佳临界值 敏感度(%) 特异度(%) 约登指数
AUC AUC 95%CI P值
血清脂联素水平 0.709 0.594~0.825 0.002 9.20 μg/mL 67.9 73.0 0.409
血清P-LAP水平 0.706 0.584~0.821 0.001 527.97 pg/mL 64.3 75.7 0.399
血清脂联素水平+P-LAP水平 0.791 0.679~0.897 0.003 — 78.6 75.7 0.542
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