妊娠期糖尿病患者血清Spexin、FoxO1水平与胰岛素抵抗及预后的关系

doi:10.11958/20250653

天津医药 ›› 2025, Vol. 53 ›› Issue (6): 610-614.doi: 10.11958/20250653

妊娠期糖尿病患者血清Spexin、FoxO1水平与胰岛素抵抗及预后的关系

杨敬敬(), 闫康禄, 孟洁, 杨春丽()

郑州大学第三附属医院产科（邮编450052）

收稿日期:2025-02-19 修回日期:2025-03-25 出版日期:2025-06-15 发布日期:2025-06-20
通讯作者: ^△E-mail：Yangcl2022@163.com
作者简介:杨敬敬（1985），女，副主任医师，主要从事妊娠糖尿病方面研究。E-mail：jing_jabc@163.com
基金资助:
河南省医学科技攻关计划（联合共建）项目(LHGJ20190366)

Relationship between serum Spexin, FoxO1 and insulin resistance as well as prognosis in patients with gestational diabetes mellitus

YANG Jingjing(), YAN Kanglu, MENG Jie, YANG Chunli()

Department of Obstetrics, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

Received:2025-02-19 Revised:2025-03-25 Published:2025-06-15 Online:2025-06-20
Contact: ^△E-mail: Yangcl2022@163.com

杨敬敬, 闫康禄, 孟洁, 杨春丽. 妊娠期糖尿病患者血清Spexin、FoxO1水平与胰岛素抵抗及预后的关系[J]. 天津医药, 2025, 53(6): 610-614.

YANG Jingjing, YAN Kanglu, MENG Jie, YANG Chunli. Relationship between serum Spexin, FoxO1 and insulin resistance as well as prognosis in patients with gestational diabetes mellitus[J]. Tianjin Medical Journal, 2025, 53(6): 610-614.

摘要/Abstract

摘要：

目的探讨妊娠期糖尿病（GDM）患者血清人神经肽（Spexin）、叉头框蛋白O1（FoxO1）水平与胰岛素抵抗（IR）及预后的关系。方法前瞻性选取198例GDM患者为GDM组，同期纳入195例体检健康孕妇为对照组。收集受试者入组的年龄、孕周、三酰甘油（TG）、孕前体质量、空腹胰岛素（FINS）、产次、空腹血糖（FBG）、总胆固醇（TC）、稳态模型胰岛素抵抗指数（HOMA-IR）。酶联免疫吸附试验（ELISA）检测受试者血清Spexin、FoxO1水平；根据妊娠结局将GDM患者分为不良妊娠组（96例）和良好妊娠组（102例）。Pearson法分析GDM患者血清Spexin、FoxO1、HOMA-IR间的相关性；Logistic回归分析影响GDM患者妊娠结局的危险因素；受试者工作特性（ROC）曲线分析血清Spexin、FoxO1水平对GDM患者妊娠结局的预测价值。结果 GDM组患者血清FINS、TG、FBG、Spexin、FoxO1及HOMA-IR水平高于对照组（P<0.01）。Pearson法分析结果显示，GDM患者血清Spexin、FoxO1水平与HOMA-IR，血清Spexin水平与FoxO1均呈正相关（P<0.05）。GDM组妊娠期高血压、剖宫产、巨大儿、新生儿畸形、低体质量儿、新生儿窒息的发生率高于对照组（P<0.05）。不良妊娠组患者血清Spexin、FoxO1水平及FINS、FBG、HOMA-IR均明显高于良好妊娠组（P<0.01）。多因素Logistic回归分析显示，Spexin、FoxO1升高是GDM患者发生不良妊娠结局的危险因素（P<0.01）。ROC曲线分析结果显示，血清Spexin和FoxO1预测GDM患者妊娠结局的曲线下面积（AUC）为分别为0.887和0.883，联合预测的AUC为0.942。结论 GDM患者血清Spexin、FoxO1升高，均与IR有关，两者联合可辅助判断GDM患者妊娠结局。

关键词: 糖尿病, 妊娠, 胰岛素抵抗, 叉头框蛋白O1, 妊娠结局, Spexin

Abstract:

Objective To investigate the correlation of serum levels of Spexin, FoxO1 and insulin resistance (IR) with prognosis in patients with gestational diabetes mellitus (GDM). Methods A total of 198 patients with GDM were prospectively selected as the GDM group, and 195 healthy pregnant women who underwent physical examinations during the same period were selected as the control group. The age at enrollment, gestational age, triglyceride (TG), pre-pregnancy body weight, fasting insulin (FINS), parity, fasting blood glucose (FBG), total cholesterol (TC) and homeostasis model assessment of insulin resistance index (HOMA-IR) of the subjects were collected. The serum levels of Spexin and FoxO1 in subjects were detected by enzyme-linked immunosorbent assay (ELISA). According to the pregnancy outcome, the GDM patients were divided into the adverse pregnancy outcome group (96 cases) and the good pregnancy outcome group (102 cases). The correlations between serum Spexin, FoxO1, and HOMA-IR in GDM patients were analyzed by Pearson's method. Logistic regression was used to analyze risk factors affecting the pregnancy outcome of GDM patients. The predictive value of serum Spexin and FoxO1 levels for the pregnancy outcome of GDM patients was analyzed by receiver operating characteristic (ROC) curve. Results The serum levels of FINS, TG, FBG, Spexin, FoxO1 and HOMA-IR were higher in the GDM group than those in the control group (P<0.01). Pearson correlation analysis showed that serum levels of Spexin and FoxO1 in GDM patients were positively correlated with HOMA-IR, and serum level of Spexin was positively correlated with FoxO1 (P<0.05). The incidences of gestational hypertension, cesarean section, macrosomia, neonatal malformations, low birth weight infants and neonatal asphyxia were higher in the GDM group than those in the control group (P<0.05). Serum levels of Spexin and FoxO1 and FINS, FBG and HOMA-IR were significantly higher in the adverse pregnancy group than those in the good pregnancy group (P<0.01). Multivariate Logistic regression analysis showed that the increased Spexin and FoxO1 were the risk factor for adverse pregnancy outcomes in GDM patients (P<0.01). The ROC curve analysis showed that the area under the curve (AUC) of serum Spexin and FoxO1 levels for predicting pregnancy outcomes in GDM patients was 0.887 and 0.883, respectively, and the AUC of combined prediction was 0.942. Conclusion Serum levels of Spexin and FoxO1 are elevated in GDM patients, and both are related to IR. The combination of the two can assist in judging the pregnancy outcome of GDM patients.

Key words: diabetes, gestational, insulin resistance, forkhead box protein O1, pregnancy outcome, Spexin

中图分类号:

R587.2

图/表 6

参考文献 16

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组别	n		产次/次		孕前体质量/kg			TC/（mmol/L）
对照组	195		1.70±0.65		54.32±6.84			4.73±1.58
GDM组	198		1.79±0.70		53.96±6.28			4.92±1.64
t			1.261		0.544			1.113
组别	TG/（mmol/L）			FBG/（mmol/L）			FINS/（mIU/L）
对照组	2.38±0.81			4.71±1.58			6.82±2.26
GDM组	3.17±1.05			6.13±2.03			13.67±4.55
t	8.358^＊＊			7.329^＊＊			17.211^＊＊
组别		Spexin/（μg/L）				FoxO1/（μg/L）			HOMA-IR
对照组		3.42±1.05				1.02±0.32			1.50±0.49
GDM组		6.73±2.17				1.67±0.51			2.83±0.83
t		14.205^＊＊				13.792^＊＊			14.062^＊＊

组别	n		产次/次		孕前体质量/kg			TC/（mmol/L）
对照组	195		1.70±0.65		54.32±6.84			4.73±1.58
GDM组	198		1.79±0.70		53.96±6.28			4.92±1.64
t			1.261		0.544			1.113
组别	TG/（mmol/L）			FBG/（mmol/L）			FINS/（mIU/L）
对照组	2.38±0.81			4.71±1.58			6.82±2.26
GDM组	3.17±1.05			6.13±2.03			13.67±4.55
t	8.358^＊＊			7.329^＊＊			17.211^＊＊
组别		Spexin/（μg/L）				FoxO1/（μg/L）			HOMA-IR
对照组		3.42±1.05				1.02±0.32			1.50±0.49
GDM组		6.73±2.17				1.67±0.51			2.83±0.83
t		14.205^＊＊				13.792^＊＊			14.062^＊＊

组别	n		妊娠期高血压		胎膜早破		剖宫产		巨大儿
对照组	195		17（8.72）		23（11.79）		29（14.87）		7（3.59）
GDM组	198		50（25.25）		29（14.65）		59（29.80）		22（11.11）
χ²			18.993^＊＊		0.696		12.595^＊＊		8.132^＊＊
组别		新生儿畸形		早产		低体质量儿		新生儿窒息
对照组		5（2.56）		11（5.64）		6（3.08）		4（2.05）
GDM组		16（8.08）		16（8.08）		17（8.59）		17（8.59）
χ²		5.911^＊		0.914		5.411^＊		8.294^＊＊

组别	n		妊娠期高血压		胎膜早破		剖宫产		巨大儿
对照组	195		17（8.72）		23（11.79）		29（14.87）		7（3.59）
GDM组	198		50（25.25）		29（14.65）		59（29.80）		22（11.11）
χ²			18.993^＊＊		0.696		12.595^＊＊		8.132^＊＊
组别		新生儿畸形		早产		低体质量儿		新生儿窒息
对照组		5（2.56）		11（5.64）		6（3.08）		4（2.05）
GDM组		16（8.08）		16（8.08）		17（8.59）		17（8.59）
χ²		5.911^＊		0.914		5.411^＊		8.294^＊＊

组别			n	年龄/岁		孕前体质量/kg		产次/次
良好妊娠组			102	28.68±5.69		54.12±6.37		1.73±0.66
不良妊娠组			96	29.44±5.83		53.79±6.18		1.85±0.71
t				0.930		0.370		1.319
组别	孕周/周			FINS/（mIU/L）		TG/（mmol/L）	TC/（mmol/L）
良好妊娠组	26.01±1.60			11.56±3.85		3.06±1.02	4.78±1.60
不良妊娠组	25.82±1.55			15.91±5.29		3.29±1.10	5.07±1.68
t	0.834			6.628^＊＊		1.592	1.244
组别		FBG/ （mmol/L）			HOMA-IR		Spexin/（μg/L）		FoxO1/（μg/L）
良好妊娠组		5.42±1.81			2.12±0.71		4.68±1.54		1.41±0.39
不良妊娠组		6.88±2.29			3.58±1.19		8.91±2.82		1.95±0.63
t		5.014^＊＊			10.567^＊＊		13.178^＊＊		7.444^＊＊

妊娠期糖尿病患者血清Spexin、FoxO1水平与胰岛素抵抗及预后的关系

Relationship between serum Spexin, FoxO1 and insulin resistance as well as prognosis in patients with gestational diabetes mellitus

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变量	β	SE	Wald χ²	P	OR	OR95%CI
FINS	0.118	0.073	2.603	0.107	1.125	0.975~1.298
FBG	0.214	0.145	2.184	0.139	1.239	0.932~1.646
Spexin	1.221	0.223	29.996	<0.001	3.391	2.190~5.249
FoxO1	2.724	0.622	38.316	<0.001	15.236	4.501~51.575
常数项	-19.358	3.127	38.316	<0.001	0.000

指标	AUC（95%CI）	截断值	敏感度/%	特异度/%	约登指数
Spexin	0.887（0.853~0.921）	7.18 μg/L	81.3	86.2	0.675
FoxO1	0.883（0.850~0.917）	1.79 μg/L	80.8	84.1	0.649
二者联合	0.942（0.919~0.964）		80.3	95.9	0.762

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