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中华妇幼临床医学杂志(电子版) ›› 2023, Vol. 19 ›› Issue (05) : 604 -610. doi: 10.3877/cma.j.issn.1673-5250.2023.05.015

论著

孕妇ABO血型联合甲状腺功能检测对预测妊娠期糖尿病的临床价值
陈絮†(), 詹玉茹, 王纯华   
  1. 汕头市第三人民医院妇产科，汕头　515000
    汕头市第三人民医院内科，汕头　515000
    汕头市第三人民医院检验科，汕头　515000
  • 收稿日期:2023-02-26 修回日期:2023-07-09 出版日期:2023-10-01
  • 通信作者: 陈絮

Clinical value of ABO blood group combined with thyroid function in prediction of gestational diabetes mellitus

Xu Chen†(), Yuru Zhan, Chunhua Wang   

  1. Department of Obstetrics and Gynecology, Shantou Third People′s Hospital, Shantou 515000, Guangdong Province, China
    Department of Internal Medicine, Shantou Third People′s Hospital, Shantou 515000, Guangdong Province, China
    Department of Laboratory, Shantou Third People′s Hospital, Shantou 515000, Guangdong Province, China
  • Received:2023-02-26 Revised:2023-07-09 Published:2023-10-01
  • Corresponding author: Xu Chen
  • Supported by:
    Healthcare Branch of Science and Technology Plan of Shantou City(210508186492847)
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引用本文：

陈絮, 詹玉茹, 王纯华. 孕妇ABO血型联合甲状腺功能检测对预测妊娠期糖尿病的临床价值[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 604-610.

Xu Chen, Yuru Zhan, Chunhua Wang. Clinical value of ABO blood group combined with thyroid function in prediction of gestational diabetes mellitus[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 604-610.

目的

探讨ABO血型联合早孕期甲状腺功能检测，对预测妊娠期糖尿病(GDM)的临床价值。

方法

选取2021年1月至2022年12月在汕头市第三人民医院进行产前检查的2 755例孕妇为研究对象。按照孕期是否罹患GDM，将其分为GDM组(n＝216)与非GDM组(n＝2 539)。采用回顾性分析法，对2组孕妇甲状腺功能检测结果、2组中不同ABO血型孕妇甲状腺功能指标进行统计学分析。采用多因素非条件logistic回归分析法对导致孕妇发生GDM的影响因素进行分析。采用受试者工作特征(ROC)曲线，分析ABO血型联合甲状腺功能检测对孕妇发生GDM的预测价值。GDM组与非GDM组孕妇的孕龄、血型构成比等一般临床资料比较，差异均无统计学意义(P>0.05)。本研究遵循的程序符合汕头市第三人民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：210508186492847)。

结果

①2组孕妇的年龄、人体质量指数(BMI)、AB血型、孕次、糖尿病家族史比较，差异有统计学意义(P<0.05)。②GDM组孕妇的血清促甲状腺激素(TSH)水平，显著高于非GDM组，而血清游离四碘甲状腺原氨酸(FT4)水平，则显著低于非GDM组，并且差异均有统计学意义(P<0.05)。③多因素非条件logistic回归分析结果显示，血清TSH水平、血清FT4水平，均为影响孕妇孕期发生GDM的独立危险因素(OR＝1.224，95%CI：1.035～1.689，P＝0.018；OR＝1.429，95%CI：1.183～1.895，P＝0.047)，而AB型血是孕妇孕期发生GDM的保护因素(OR＝0.827，95%CI：0.719～0.963，P＝0.005)。⑤GDM组中，A型、B型、O型、AB型孕妇的血清TSH水平总体比较，差异有统计学意义(P<0.05)。⑥采用ROC曲线对ABO血型联合甲状腺功能指标检测预测孕妇发生GDM的结果显示，孕妇血型、血清TSH水平和血清FT4水平与上述3项指标联合预测GDM的曲线下面积(AUC)分别为0.748、0.759、0.804、0.886。

结论

AB血型是GDM发生的保护因素，ABO血型联合甲状腺功能指标对GDM有较高的预测诊断价值。

关键词: 糖尿病，妊娠, 促甲状腺素, ABO血型, 影响因素分析, ROC曲线, 孕妇
Objective

To explore the clinical value of ABO blood type combined with thyroid function detection in early pregnancy to predict gestational diabetes (GDM).

Methods

A total of 2 755 pregnant women who underwent prenatal examination at Shantou Third Hospital from January 2021 to December 2022 were selected in this study. According to whether they combined with GDM during pregnancy, they were divided into GDM group (n=216) and non-GDM group (n=2 539). A retrospective analysis was used to analyze thyroid function indicators in pregnant women of different ABO blood types between two groups. Multivariate non-conditional logistic regression analysis was used to analyze the influencing factors leading to the occurrence of GDM in pregnant women. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of ABO blood type combined with thyroid function test for the occurrence of GDM in pregnant women. There were no significant differences in general clinical data such as gestational age and blood type composition between the GDM group and the non-GDM group (P>0.05). The procedures followed in this study conformed to the ethical standards formulated by the Ethics Committee of Shantou Third Hospital, and were approved by the Ethics Committee (Approval No. 210508186492847).

Results

①There were significant differences in age, body mass index (BMI), ABO blood type, parity, and family history of diabetes between two groups (P<0.05). ②The serum thyrotropin (TSH) level in GDM group was significantly higher than that in non-GDM group, while the serum free thyroxine (FT4) level was significantly lower than that in non-GDM group, and the differences were statistically significant (P<0.05). ③Multivariate non-conditional logistic regression analysis showed that serum TSH and FT4 levels were independent risk factors for the occurrence of GDM during pregnancy (OR=1.224, 95%CI: 1.035-1.689, P=0.018; OR=1.429, 95%CI: 1.183-1.895, P=0.047), while AB blood type was a protective factor for the occurrence of GDM during pregnancy (OR=0.827, 95%CI: 0.719-0.963, P=0.005). ⑤There were significant differences in serum TSH levels among pregnant women with A, B, O, and AB blood types in GDM group (P<0.05). ⑥The ROC curve showed that the area under curve (AUC) for predicting GDM using ABO blood type combined with thyroid function test was 0.748 for blood type alone, 0.759 for serum TSH level alone, 0.804 for serum FT4 level alone, and 0.886 for the combination of the three indicators.

Conclusions

AB blood type is a protective factor for the occurrence of GDM, and the combination of ABO blood type and thyroid function indicators has high diagnostic value for predicting GDM.

Key words: Diabetes, gestational, Thyrotropin, ABO blood type, Root cause analysis, ROC curve, Pregnant women
表1 2两组孕妇一般临床资料比较
组别 例数 年龄[例数(%)] ABO血型[例数(%)]
≤30岁 >30岁 A型 B型 AB型 O型
GDM组 216 89(41.2) 127(58.8) 73(33.8) 69(31.9) 20(9.3) 54(25.0)
非GDM组 2 539 1 273(50.1) 1 266(49.9) 719(28.3) 777(30.6) 526(20.7) 517(20.4)
统计量   χ2＝6.36 χ2＝2.92 χ2＝0.17 χ2＝16.45 χ2＝2.61
P值   0.012 0.088 0.681 <0.001 0.106
组别 例数 BMI [例数(%)] 孕次[例数(%)] 孕龄(周，±s) 糖尿病家族史[例数(%)]
≤24 kg/m2 >24 kg/m2 1次 ≥2次
GDM组 216 86(39.8) 130(60.2) 112(51.9) 104(48.1) 12.1±2.2 40(18.5)
非GDM组 2 539 1 227(48.3) 1 312(51.7) 1 491(58.7) 1 048(41.3) 12.1±2.1 324(12.8)
统计量   χ2＝5.78 χ2＝3.86 t＝3.71 t＝5.76
P值   0.016 0.049 0.435 0.016
表2 2组孕妇甲状腺功能检测结果比较(±s)
组别 例数 TSH(mIU/L) FT3(pmol/L) FT4(pmol/L)
GDM组 216 2.2±0.5 4.9±0.8 14.9±3.1
非GDM组 2 539 1.6±0.4 5.0±1.0 16.2±3.5
t值   20.53 1.33 5.29
P值   <0.001 0.184 <0.001
表3 2组不同血型孕妇甲状腺功能指标检测结果比较(±s)
ABO血型 GDM组(n＝216) 非GDM组(n＝2 539)
例数 TSH(mIU/L) FT3(pmol/L) FT4(pmol/L) 例数 TSH(mIU/L) FT3(pmol/L) FT4(pmol/L)
A型 73 2.12±0.52 4.87±0.75 14.8±3.0 719 1.55±0.32 4.87±0.97 16.0±3.0
B型 69 2.12±0.52 4.85±0.76 15.2±3.1 777 1.63±0.44 4.88±0.99 16.3±3.2
AB型 20 2.49±0.55 4.79±0.69 14.9±3.1 526 1.57±0.33 4.99±0.96 15.9±3.8
O型 54 2.11±0.54 4.88±0.82 14.8±3.2 517 1.59±0.36 5.11±0.96 16.6±3.4
F值   3.02 0.08 0.59   0.56 0.78 2.02
P值   0.031 0.973 0.622   0.642 0.507 0.113
表4 GDM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
年龄>30岁(vs年龄≤30岁) 0.048 0.013 2.684 0.101 1.185 0.964～1.583
BMI>24 kg/m2(vs BMI≤24 kg/m2) 0.094 0.063 2.583 0.108 1.559 1.231～1.916
血型为非AB型(vs血型为AB型) -0.055 0.098 7.839 0.005 0.827 0.719～0.963
孕次≥2次(vs孕次为1次) 0.079 0.082 1.774 0.183 1.268 0.983～1.684
无糖尿病家族史(vs有糖尿病家族史者) 0.053 0.071 3.446 0.063 1.593 1.349～1.885
TSH水平>2.5 mIU/L(vs TSH≤2.5 mIU/L) 0.061 0.044 5.573 0.018 1.224 1.035～1.689
FT4水平<11.45 pmol/L(vs FT4≥11.45 pmol/L) 0.012 0.049 3.938 0.047 1.429 1.183～1.895
图1 ABO血型联合甲状腺功能指标预测GDM的ROC曲线注：GDM为妊娠期糖尿病，ROC曲线为受试者工作特征曲线，TSH为甲状腺激素，FT4为游离甲状腺素
表5 ABO血型联合甲状腺功能指标预测GDM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 95%CI P值
ABO血型 0.748 0.647～0.850 <0.001 — 93.8 71.4 65.2
血清TSH水平 0.759 0.663～0.855 <0.001 2.94 mIU/L 64.6 83.3 47.9
血清FT4水平 0.804 0.717～0.890 <0.001 15.24 pmol/L 75.0 83.3 58.3
以上3项指标联合 0.886 0.822～0.950 <0.001 — 77.1 81.5 58.6
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