早孕期母体血清中PAPP-A水平与妊娠期糖尿病的相关性及预测价值研究

摘要

Objective:To assess the correlation of serum pregnancy-associated plasma protein A(PAPP-A) level with gestational diabetes mellitus(GDM) and its predictive value in predicting GDM.Methods:The clinical data of 599 GDM patients(GDM group) and 986 control pregnant women(control group) undergoing antenatal examination and delivery were retrospectively analyzed.The labor condition and serum PAPP-A levels of first-trimester were compared between the two groups.A binary Logistic regression analysis was employed to explore the risk factors of GDM.The area under receiver operating characteristic(ROC-AOC) curve was used to determine the predictive value of PAPP-A in prediction of GDM.Results:①The ratio of age,BMI,family history of diabetes,parity,IVF-ET,and cesarean section of GDM group were higher than those of control group(P ＜ 0.01);gestational weeks of labor in GDM group was less than that of control group(P＜0.01);②The PAPP-A MoM in GDM group(0.88(0.60-1.28)) was lower than that of control group(0.97(0.67-1.37) (P＜0.01);③Logistic regression analysis showed that:PAPP-A was negatively related with the onset of GDM,OR was 0.794 (95％ CI 0.641-0.983). ④The ROC-AUC of the clinical risk score was 0.680(95％CI 0.653-0.707),the ROCAUC the adjusted score including PAPP-A MoM was 0.682 (95％ CI 0.655-0.709),there was no significant difference between the two ROC-AUC (P =0.429).Conclusions:Serum PAPP-A is an independent influence factor in pregnant women who subsequently develop GDM.However,the prediction value is limited.%目的:分析早孕期母体外周血中妊娠相关血浆蛋白A(PAPP-A)水平与妊娠期糖尿病(GDM)的关系,探究PAPP-A对GDM的预测价值.方法:对完成产前检查并分娩的599例GDM孕妇(GDM组)和986例正常孕妇(对照组)的临床资料进行回顾性分析,比较两组孕妇早孕期血清中PAPP-A水平的差异,采用二分类Logistic回归分析GDM的相关影响因素,采用受试者工作特征(ROC)曲线分析PAPP-A对GDM的预测价值.结果:①GDM组年龄、孕前BMI、糖尿病家族史、经产妇、辅助生殖技术的比例、剖宫产的比例高于对照组,差异有统计学意义(P＜0.01);GDM组分娩孕周早于对照组,差异有统计学意义(P＜0.01).②GDM组PAPP-A MoM值为0.88(0.60～ 1.28),低于对照组的0.97(0.67 ～ 1.37),差异有统计学意义(P＜0.01).③Logistic回归分析:PAPP-A与GDM的发生呈负相关,比值比(OR)值为0.794(95％ CI 0.641 ～0.983).④临床资料预测GDM的ROC曲线下面积(ROC-AUC)为0.680(95％ CI 0.653 ～0.707),临床资料联合PAPP-A MoM预测ROC-AUC为0.682 (95％CI 0.655～0.709),两者差异无统计学意义(P =0.429).结论:尽管早孕期孕妇外周血中PAPP-A水平是GDM发生的独立影响因素,但其对GDM的预测价值有限.