性激素结合球蛋白在预测妊娠期糖尿病中的应用

摘要

Objective To explore the value of sex hormone binding globulin(SHBG)as a biomarker in prediction of gestational diabetes mellitus(GDM)at first-trimester stage.Methods Two hundred and sixty cases of pregnant women during the first trimester (13 - 16 weeks of gestation)were enrolled in this study.The content of SHBG in the serum was measured at 13-16 weeks of gestation and followed with oral glucose tolerance test at 24-28 weeks.The results of screening of GDM showed that 21 cases in GDM group,and 239 cases in normal control group. Age,body mass index(BMI),multipara,family history of diabetes,gestational weeks,delivery, cesarean section and neonatal amniotic fluid index,body mass and SHBG content were compared in 2 groups of pregnant women.Results The ratio of BMI,cesarean section and neonatal body weight in GDM group were higher than that in normal control group,while the production of gestational week,amniotic fluid index and SHBG content were lower than that of normal control group(P<0.05).ROC curve analysis(AUC=0.877,95% CI =0.806 -0.948)found that when the cutoff value of SHBG was 175.86 nmol/L, the predictive sensitivity was 90.48%, the specificity was 66.94%,the positive predictive value was 19.19%,and the negative predictive value was 98.78%.Conclusion Serum SHBG content in early pregnancy(13 -16 weeks)can be used as a biomarker to predict GDM effectively.%目的 探讨性激素结合球蛋白(sex hormone binding globulin,SHBG)作为生物标记在孕早期预测妊娠期糖尿病(gestational diabetes mellitus,GDM)的应用价值.方法 将妊娠13~16周孕妇260例在孕24~28周应用葡萄糖耐量试验(oral glucose tolerance test,OGTT)进行妊娠期糖尿病的筛选,结果 筛选出GDM 21例为GDM组,其余239例为正常对照组.比较2组孕妇年龄、体质量指数、经产妇比例、家族糖尿病史、生产孕周、分娩羊水指数、剖宫产、新生儿体质量和SHBG含量.结果GDM组体质量指数和剖宫产比例均高于正常对照组,生产孕周低于正常对照组,差异有统计学意义(P<0.05);GDM组羊水指数和SHBG含量均低于正常对照组,新生儿体质量高于正常对照组,差异有统计学意义(P<0.05).ROC曲线分析(AUC=0.877,95%CI=0.806~0.948)显示,当SHBG截断值为175.86 nmol/L时,预测敏感度为90.48%,特异度为66.94%,阳性预测值为19.19%,阴性预测值为98.78%.结论 孕早期(13~16周)血清中SHBG含量可作为生物标记,可对GDM进行有效预测.