妊娠早期血清分泌型卷曲相关蛋白5水平对于妊娠糖尿病的早期诊断预测价值

摘要

目的 探讨妊娠早期血清卷曲相关蛋白5(Sfrp-5)水平对于妊娠糖尿病(GDM)的早期诊断预测价值.方法 纳入孕妇320例,根据孕24～28周行759口服葡萄糖耐量试验结果,将纳入孕妇分为GDM组32例和非GDM组288例.两组孕妇分别在妊娠早期和中期时检测血清Sfrp-5水平,并进行胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能[β细胞功能指数(HOMA-β)、胰岛素曲线下面积(INSAUC)、血糖曲线下面积(PGAUC)、两者比值(INSAUC/PGAUC)和早期胰岛素分泌功能指数(△I30/△G30)]计算.通过ROC曲线分析血清Sfrp-5水平对于GDM的早期预警价值,并计算出最佳切点值(Cut-off值).采用Pearson相关分析血清Sfrp-5水平与GDM、孕期BMI、HOMA-IR、胰岛β细胞功能指标的相关性,采用logistic回归分析GDM发生的独立危险因素.结果 GDM组孕妇妊娠早期和中期妊娠血清Sfrp-5水平、HOMA-β、INSAUC/PGAUC和△I30/△G30均明显低于非GDM组,HOMA-IR明显高于非GDM组,差异均有统计学意义(均P＜0.05).妊娠早期和中期血清Sfrp-5水平与GDM的发生均呈负相关(r=-0.636和-0.684,均P＜0.01).妊娠早期血清Sfrp-5水平的诊断价值最高,AUC为0.788,95％CI为0.712～0.855,Cut-off值为10.5ng/ml,灵敏度为82％,特异度为78％.妊娠早期血清Sfrp-5水平＜10.5ng/ml和妊娠中期血清Sfrp-5水平＜6.8ng/ml为GDM发生的独立危险因素(OR =1.55和1.22,均P＜0.05).结论 妊娠早期时血清Sfrp-5水平下降是GDM的重要预警因子.%Objective To assess the prediction value of first trimester serum secreted frizzle-related protein-5(Sfrp-5) levels for gestational diabetes mellitus (GDM).Methods Three hundred and twenty pregnant women were enrolled in this study and divided to two groups based on glucose tolerance screening:GDM group(n=28) and non-GDM group(n=288).Serum Sfrp-5 levels were measured on first and second trimester of pregnancy.All enrolled pregnant women were receiving insulin resistance(HOMA-IR) and beta cell function evaluation (HOMA-β,INSAUC,PGAUC,INSAUC/PGAUC and △l30/△G30).ROC analysis was used for evaluate the early prediction value of Sfrp-5 for GDM.Pearson correlation was used to analyze the association between GDM and Sfrp-5.Logistic regression was used to determinate the risk factors for GDM.Reaulta The serum Sfrp-5 level,HOMA-β,INSAUC/PGAUC and △I30/△G30 in GDM group were lower than those in non-GDM group on both first and second trimester of pregnancy,while HOMA-IR were higher than those in non-GDM group(all P＜0.05).Correlation analysis showed that contents of Sfrp-5 were negatively associated with GDM on both first and second trimester of pregnancy.ROC analysis suggested that AUC of Sfrp-5 on first trimester of pregnancy was 0.788,the sensitivity and specificity were 82％ and 78％ when 10.5ng/ml was taken as Cut-off value.Logistic analysis indicated that serum Sfrp-5 on first (＜10.5ng/ml) and second trimester (＜6.8ng/ml) of pregnancy were independent risk factors for GDM (OR=1.55 and 1.22,both P＜0.05).Conclusion The reduction of serum Sfrp-5 level on first trimester of pregnancy may be an important warning marker for GDM.