妊娠期糖尿病患者血清GPER1、CFH水平与妊娠结局的关系

doi:10.11958/20241950

摘要/Abstract

摘要：

目的探讨妊娠期糖尿病（GDM）患者血清G蛋白偶联雌激素受体1（GPER1）、补体因子H（CFH）水平与妊娠结局的关系。方法选取GDM患者120例（GDM组）和健康孕妇60例（对照组），根据妊娠结局将GDM患者分为不良妊娠结局（APO）组（50例）和非APO组（70例）。收集GDM患者基本资料；检测空腹血糖、空腹胰岛素和血脂四项，并按照稳态模型计算胰岛素抵抗指数（HOMA-IR）；采用酶联免疫吸附试验检测血清GPER1、CFH水平。Pearson相关分析GDM患者血清GPER1、CFH水平与HOMA-IR的相关性；多因素非条件Logistic回归和受试者工作特征（ROC）曲线分析血清GPER1、CFH水平与GDM患者APO的关系及预测能效。结果与对照组比较，GDM组血清GPER1、CFH水平升高（P<0.05）。GDM患者血清GPER1、CFH水平与HOMA-IR呈正相关（r分别为0.722和0.714，P<0.001）。与非APO组比较，APO组血清GPER1、CFH水平升高（P<0.05）。HOMA-IR、GPER1、CFH水平升高为GDM患者APO的独立危险因素（P<0.05）。血清GPER1、CFH联合预测[AUC=0.887（95%CI：0.816~0.937）]GDM患者APO的效能优于血清GPER1[AUC=0.789（95%CI：0.705~0.858）]、CFH[AUC=0.786（95%CI：0.701~0.856）]单独预测。结论 GDM患者血清GPER1、CFH水平升高，与胰岛素抵抗增强和APO密切相关，二者联合对APO有较高的预测能效。

关键词: 妊娠期糖尿病, G蛋白偶联雌激素受体1, 妊娠结局, 补体因子H, 胰岛素抵抗

Abstract:

Objective To investigate the relationship between serum G protein-coupled estrogen receptor 1 (GPER1), complement factor H (CFH) levels and pregnancy outcomes in patients with gestational diabetes mellitus (GDM). Methods A total of 120 patients with GDM (GDM group) and 60 healthy pregnant women (control group) were included in this study. According to the pregnancy outcome, GDM patients were divided into the adverse pregnancy outcome (APO) group (50 cases) and the non-APO group (70 cases). The basic data of GDM patients were collected. Fasting blood glucose, fasting insulin and blood lipids were measured, and homeostasis model assessment of insulin resistance index (HOMA-IR) was calculated. The serum levels of GPER1 and CFH were detected by enzyme-linked immunosorbent assay. Pearson correlation analysis was used to analyze the correlation between serum levels of GPER1, CFH and HOMA-IR in GDM patients. Multivariate unconditional Logistic regression and receiver operating characteristic (ROC) curve were used to analyze the relationship between serum GPER1 and CFH levels and APO in GDM patients and to predict energy efficiency. Results Compared with the control group, serum levels of GPER1 and CFH were increased in the GDM group (P < 0.05). Serum GPER1 and CFH levels were positively correlated with HOMA-IR in GDM patients (r = 0.722 and 0.714, respectively, P < 0.001).Compared with the non-APO group, serum levels of GPER1 and CFH were increased in the APO group (P < 0.05). Elevated levels of HOMA-IR, GPER1 and CFH were independent risk factors for APO in GDM patients (P < 0.05). The combined prediction of serum GPER1 and CFH [AUC=0.887 (95%CI: 0.816-0.937)] was superior to serum GPER1 [AUC=0.789 (95%CI: 0.705-0.858)] and CFH [AUC=0.786 (95%CI: 0.701-0.856)] alone in predicting APO in GDM patients. Conclusion Serum levels of GPER1 and CFH in GDM patients are increased, which are closely related to the enhancement of insulin resistance and APO. The combination of the two has a higher predictive efficiency for APO.

Key words: gestational diabetes mellitus, G protein-coupled estrogen receptor 1, pregnancy outcome, complement factor H, insulin resistance

中图分类号:

R714.25

图/表 6

参考文献 26

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组别	n	年龄/岁	孕周/周	BMI/（kg/m²）	初产妇
对照组	60	28.77±2.64	25.63±1.30	25.66±2.17	42（70.00）
GDM组	120	29.49±2.92	25.88±1.26	27.56±2.30	80（66.67）
t或χ²		1.618	1.238	5.322^＊	0.204

组别	n	年龄/岁	孕周/周	BMI/（kg/m²）	初产妇
对照组	60	28.77±2.64	25.63±1.30	25.66±2.17	42（70.00）
GDM组	120	29.49±2.92	25.88±1.26	27.56±2.30	80（66.67）
t或χ²		1.618	1.238	5.322^＊	0.204

组别	n	HOMA-IR	GPER1/（ng/L）	CFH/（mg/L）
对照组	60	1.72±0.23	109.43±18.95	293.00±46.93
GDM组	120	2.48±0.36	140.25±29.07	360.10±57.40
t		8.538^＊	7.836^＊	17.278^＊

组别	n	HOMA-IR	GPER1/（ng/L）	CFH/（mg/L）
对照组	60	1.72±0.23	109.43±18.95	293.00±46.93
GDM组	120	2.48±0.36	140.25±29.07	360.10±57.40
t		8.538^＊	7.836^＊	17.278^＊

组别			n	年龄/岁		孕周/周		BMI/（kg/m²）
非APO组			70	28.96±2.81		25.74±1.34		27.17±2.22
APO组			50	30.24±2.95		26.08±1.14		28.10±2.31
t或χ²				2.416^＊		1.446		2.243^＊
组别	初产妇			吸烟史		饮酒史	FPG/（mmol/L）
非APO组	44（62.86）			11（15.71）		7（10.00）	7.75±0.85
APO组	36（72.00）			10（20.00）		7（14.00）	8.00±0.37
t	1.097			0.371		0.453	2.155^＊
组别	HOMA-IR			TC/（mmol/L）		TG/（mmol/L）	HDL-C/（mmol/L）
非APO组	2.33±0.32			5.17±0.72		2.06±0.39	1.28±0.12
APO组	2.69±0.30			5.54±1.45		2.19±0.71	1.24±0.18
t	6.172^＊			1.651		1.183	1.342
组别		LDL-C/（mmol/L）			GPER1/（ng/L）				CFH/（mg/L）
非APO组		2.59±0.95			128.20±26.20				336.51±47.14
APO组		2.82±0.41			157.11±24.26				393.12±54.44
t		1.785			6.145^＊				6.079^＊