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

doi:10.3877/cma.j.issn.1673-5250.2023.03.009

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)
组别	例数	分娩年龄(岁，±s)	孕前BMI(kg/m²，±s)	分娩孕龄(周，±s)	<2次	≥2次	<2次	≥2次	FPG(mmol/L，±s))	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(%)]
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)	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)
组别	例数	分娩年龄(岁，±s)	孕前BMI(kg/m²，±s)	分娩孕龄(周，±s)	<2次	≥2次	<2次	≥2次	FPG(mmol/L，±s))	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(%)]
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)	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

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
指标	AUC	AUC 95%CI	P值	最佳临界值	敏感度(%)	特异度(%)	约登指数
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

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
指标	AUC	AUC 95%CI	P值	最佳临界值	敏感度(%)	特异度(%)	约登指数
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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