摘要
目的探讨血清微小RNA-21(miR-21)、胰腺衍生因子(pancreatic derived factor,PANDER)、妊娠相关蛋白A(pregenancy-associated plasma protein A,PAPP-A)在妊娠期糖尿病(gestational diabetes mellitus,GDM)患者中的表达水平及其对GDM患者不良妊娠结局的预测作用。方法选取2020年1月至2022年9月绵阳市游仙区妇幼保健院收治的GDM患者作为GDM组,另选取同期产检正常孕妇作为对照组。比较两组临床资料及血清miR-21、PANDER、PAPP-A水平。随访至产后,统计妊娠结局,采用多因素Logistic回归分析探讨GDM患者发生不良妊娠结局的影响因素;采用受试者工作特征(receiver operating characteristic,ROC)曲线及其曲线下面积(area under curve,AUC)分析各指标预测GDM患者不良妊娠结局的价值。结果共纳入308例研究对象,其中GDM组和对照组各154例。GDM组空腹血糖及血清PANDER、PAPP-A、miR-21水平均显著高于对照组(P<0.05)。GDM组患者中,35例(22.73%)发生不良妊娠结局。不良妊娠组空腹血糖、低血糖次数及血清PANDER、PAPP-A、miR-21水平均高于良好妊娠组(P<0.05)。校正混杂因素后,多因素Logistic回归分析显示,低血糖次数[OR=4.526,95%CI(2.014,10.171)]、PANDER[OR=1.011,95%CI(1.001,1.021)]、PAPP-A[OR=1.215,95%CI(1.069,1.382)]、miR-21[OR=11.143,95%CI(2.115,58.712)]与GDM患者不良妊娠结局的发生风险显著相关(P<0.05)。ROC曲线分析显示,低血糖次数、PANDER、PAPP-A、miR-21联合预测GDM患者不良妊娠结局的AUC为[0.950,95%CI(0.907,0.993)],均高于单项指标预测的AUC。结论与正常孕妇相比,GDM患者血清miR-21、PANDER、PAPP-A水平升高,且miR-21、PANDER、PAPP-A水平是GDM患者发生不良妊娠结局的危险因素,miR-21、PANDER、PAPP-A或可作为评估GDM患者妊娠结局的生物学指标。
Objective To investigate the level of serum microRNA-21(miR-21),pancreatic derived factor(PANDER),pregnancy-associated plasma protein A(PAPP-A)in gestational diabetes mellitus(GDM)and their predictive effect on adverse pregnancy outcomes in GDM patients.Methods Patients admitted to the Youxian Maternal and Child Health Hospital of Mianyang from January 2020 to September 2022 were selected as the GDM group and another normal pregnant women who underwent prenatal examinations during the same time were selected as the control group.Compare the clinical data and serum miR-21,PANDER,and PAPP-A levels between two groups.Both groups were followed up until the postpartum and pregnancy outcomes were counted.Multivariate Logistic regression analysis was used to explore the factors influencing the occurrence of adverse pregnancy outcomes in patients with GDM.The receiver operating characteristic(ROC)curve and area under curve(AUC)were used to analyze the value of indicators in predicting the adverse pregnancy outcomes.Results 308 subjects were included,with 154 in each group.The fasting plasma glucose levels,PANDER,PAPP-A,and miR-21 in the GDM group were higher than those in the control group(P<0.05).The hypoglycemia frequency and the levels of fasting plasma glucose,PANDER,PAPP-A,miR-21 in the adverse pregnancy group were higher than those in the good pregnancy group(P<0.05).Multivariate Logistic regression analysis shows that,after adjusting confounding factors,hypoglycemia frequency[OR=4.526,95%CI(2.014,10.171)],PANDER[OR=1.011,95%CI(1.001,1.021)],PAPP-A[OR=1.215,95%CI(1.069,1.382)]and miR-21[OR=11.143,95%CI(2.115,58.712)]were significantly associated with the risk of adverse pregnancy outcomes in GDM patients(all P<0.05).ROC curve analysis shows that,the AUC of the combination of hypoglycemia frequency,PANDER,PAPP-A and miR-21 in predicting the adverse pregnancy outcomes were[0.950,95%CI(0.907,0.993)],higher than that of each single indicator.Conclusion Compared with normal pregnant women,the serum levels of miR-21,PANDER and PAPP-A were increased in GDM patients,and the levels of miR-21,PANDER and PAPP-A were risk factors for adverse pregnancy outcomes.miR-21,PANDER and PAPP-A may be used as biological indicators to evaluate the pregnancy outcome of GDM.
作者
蒋春容
唐敏鑫
李晨
章培
JIANG Chunrong;TANG Minxin;LI Chen;ZHANG Pei(Department of Laboratory,Youxian Maternal and Child Health Hospital,Mianyang 621000,Sichuan Province,China;Department of Laboratory,Chongqing Orthopedic Hospital of Traditional Chinese Medicine,Chongqing 400012,China;Department of Obstetrics and Gynecology,Chengdu Second People's Hospital,Chengdu 610021,China)
出处
《医学新知》
CAS
2024年第8期897-905,共9页
New Medicine
基金
四川省科技计划项目(2020YFG0737)。
关键词
妊娠期糖尿病
不良妊娠结局
胰腺衍生因子
妊娠相关蛋白A
微小RNA-21
Gestational diabetes mellitus
Adverse pregnancy outcomes
Pancreatic derived factor
Pregnancy-associated plasma protein A
MicroRNA-21
