血清HbA1c、Alarin及Ficolin-3水平对妊娠期糖尿病患者妊娠结局的预测价值

doi:10.11958/20231789

天津医药 ›› 2024, Vol. 52 ›› Issue (6): 625-629.doi: 10.11958/20231789

血清HbA1c、Alarin及Ficolin-3水平对妊娠期糖尿病患者妊娠结局的预测价值

常鸿¹(), 张科伟¹, 徐静², 崔晓敏¹, 杨菲菲¹^,^△()

1 烟台业达医院产科（邮编264006）
2 河北医科大学第一医院产科

收稿日期:2023-11-24 修回日期:2023-12-31 出版日期:2024-06-15 发布日期:2024-06-06
通讯作者: ^△E-mail：155226111@qq.com
作者简介:常鸿（1975），女，副主任医师，主要从事产科危重症方面研究。E-mail：ch092227@126.com
基金资助:
河北省卫生和计划生育委员会科研基金项目(20200123)

Clinical value of serum HbA1c, Alarin and Ficolin-3 levels in predicting pregnancy outcome in patients with gestational diabetes mellitus

CHANG Hong¹(), ZHANG Kewei¹, XU Jing², CUI Xiaomin¹, YANG Feifei¹^,^△()

1 Department of Obstetrics, Yantai Yeda Hospital, Yantai 264006, China
2 Department of Obstetrics, the First Hospital of Hebei Medical University

Received:2023-11-24 Revised:2023-12-31 Published:2024-06-15 Online:2024-06-06
Contact: ^△E-mail: 155226111@qq.com

常鸿, 张科伟, 徐静, 崔晓敏, 杨菲菲. 血清HbA1c、Alarin及Ficolin-3水平对妊娠期糖尿病患者妊娠结局的预测价值[J]. 天津医药, 2024, 52(6): 625-629.

CHANG Hong, ZHANG Kewei, XU Jing, CUI Xiaomin, YANG Feifei. Clinical value of serum HbA1c, Alarin and Ficolin-3 levels in predicting pregnancy outcome in patients with gestational diabetes mellitus[J]. Tianjin Medical Journal, 2024, 52(6): 625-629.

摘要/Abstract

摘要：

目的探讨妊娠期糖尿病（GDM）患者血清糖化血红蛋白A1c（HbA1c）、Alarin及纤维凝胶蛋白-3（Ficolin-3）联合对不良妊娠结局的预测价值。方法选取入院产检并住院分娩的129例GDM患者为GDM组，选取同期于本院产检并分娩的133例糖耐量试验结果正常孕妇作为对照组。采用全自动糖化血红蛋白分析仪检测血清HbA1c水平；酶联免疫吸附试验检测血清Alarin和Ficolin-3水平；Pearson法分析GDM患者血清HbA1c、Alarin、Ficolin-3水平与餐后2 h血糖（2 h PG）、空腹血糖（FBG）、胰岛素抵抗指数（HOMA-IR）的相关性；Logistic回归分析HbA1c、Alarin、Ficolin-3水平与GDM患者发生不良妊娠结局的关系；绘制受试者工作特征（ROC）曲线，分析血清HbA1c、Alarin、Ficolin-3水平对GDM患者发生不良妊娠结局的预测价值。结果 GDM组2 h PG、FBG、HOMA-IR及血清HbA1c、Alarin、Ficolin-3水平均高于对照组（P<0.05）。GDM患者血清HbA1c、Alarin、Ficolin-3水平与2 h PG、FBG、HOMA-IR均呈正相关（P<0.05）。血糖控制差的GDM患者血清HbA1c、Alarin、Ficolin-3水平均高于血糖控制好的GDM患者（P<0.05）。不良妊娠结局的GDM患者上述三指标水平均高于无不良妊娠结局GDM患者（P<0.05）。HbA1c、Alarin、Ficolin-3水平升高均是GDM患者发生不良妊娠结局的独立危险因素（P<0.05）。HbA1c、Alarin、Ficolin-3单独及联合预测GDM患者发生不良妊娠结局的曲线下面积分别为0.840、0.865、0.815和0.979。结论 GDM患者血清HbA1c、Alarin、Ficolin-3水平异常升高，三者联合检测可提高不良妊娠结局的预测价值。

关键词: 糖尿病, 妊娠, 糖基化血红蛋白A, 妊娠结局, Alarin, 纤维凝胶蛋白-3

Abstract:

Objective To explore the value of the combination of serum hemoglobin A1c (HbA1c), Alarin and Ficolin-3 in predicting adverse pregnancy outcomes in patients with gestational diabetes mellitus (GDM). Methods From March 2021 to March 2023, 129 GDM patients who underwent prenatal examination and hospital delivery in Yantai Yeda Hospital were collected as the GDM group, while 133 pregnant women with normal glucose tolerance test results were regarded as the control group. Fully automated glycated hemoglobin analyzer was applied to detect serum HbA1c level. Enzyme linked immunosorbent assay (ELISA) was applied to detect serum Alarin and Ficolin-3 levels. Pearson method was used to analyze the correlation between serum HbA1c, Alarin, Ficolin-3 levels and 2 hour postprandial glucose (2 h PG), fasting blood glucose (FBG) and homeostasis model assessment method for insulin resistance (HOMA-IR) in GDM patients. Logistic regression was applied to analyze the relationship between HbA1c, Alarin, Ficolin-3 levels and adverse pregnancy outcomes in GDM patients. Receiver operating characteristic (ROC) curve was plotted to analyze the value of serum HbA1c, Alarin and Ficolin-3 levels in predicting adverse pregnancy outcomes in GDM patients. Results The 2 h PG, FBG, HOMA-IR, and serum HbA1c, Alarin, and Ficolin-3 levels were significantly higher in the GDM group than those in the control group (P<0.05). The serum levels of HbA1c, Alarin and Ficolin-3 were positively correlated with 2 h PG, FBG and HOMA-IR in GDM patients (P<0.05). The serum HbA1c, Alarin and Ficolin-3 levels were greatly higher in GDM patients with poor blood glucose control than those in GDM patients with good blood glucose control (P<0.05). The above levels of three indicators in GDM patients with adverse pregnancy outcomes were significantly higher than those in GDM patients without adverse pregnancy outcomes (P<0.05). Elevated levels of HbA1c, Alarin and Ficolin-3 were independent risk factors for adverse pregnancy outcomes in GDM patients (P<0.05). The area under the curves of HbA1c, Alarin and Ficolin-3 alone and in combination were 0.840, 0.865, 0.815 and 0.979, respectively in predicting adverse pregnancy outcomes in GDM patients. Conclusion The serum HbA1c, Alarin and Ficolin-3 levels are abnormally elevated in GDM patients, and the combined detection of the three can improve the value in predicting adverse pregnancy outcomes.

Key words: diabetes, gestational, glycated hemoglobin A, pregnancy outcome, Alarin, Ficolin-3

中图分类号:

R714.256

图/表 7

参考文献 22

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组别		n	年龄/岁		孕前BMI/（kg/m²）		SBP/（mmHg）		DBP/（mmHg）		初产妇		孕期/周		孕次/次		2 h PG/（mmol/L）
对照组		133	27.90±4.09		22.94±2.87		119.82±10.27		70.32±6.85		92（69.2）		27.04±1.28		1.98±0.40		6.43±1.57
GDM组		129	28.52±4.02		23.03±3.10		120.45±11.06		70.94±6.30		89（69.0）		27.10±1.45		2.01±0.36		10.48±1.76
t或χ²			1.231		0.244		0.478		0.765		0.001		0.374		0.642		19.666^＊＊
组别	FBG/（mmol/L）			HOMA-IR		HDL-C/（mmol/L）		LDL-C/（mmol/L）		TG/（mmol/L）		TC/（mmol/L）		HbA1c/%		Alarin/（mg/L）		Ficolin-3/（μg/L）
对照组	4.12±0.69			1.72±0.55		1.36±0.30		2.50±0.69		2.36±0.80		4.95±0.94		3.77±0.72		0.21±0.06		20.55±6.05
GDM组	6.51±0.83			3.60±0.71		1.38±0.35		2.53±0.79		2.41±0.76		5.13±1.16		6.00±1.14		0.42±0.14		32.28±10.42
t或χ²	25.364^＊＊			24.249^＊＊		0.501		0.329		0.515		1.388		18.838^＊＊		16.350^＊＊		11.103^＊＊

组别		n	年龄/岁		孕前BMI/（kg/m²）		SBP/（mmHg）		DBP/（mmHg）		初产妇		孕期/周		孕次/次		2 h PG/（mmol/L）
对照组		133	27.90±4.09		22.94±2.87		119.82±10.27		70.32±6.85		92（69.2）		27.04±1.28		1.98±0.40		6.43±1.57
GDM组		129	28.52±4.02		23.03±3.10		120.45±11.06		70.94±6.30		89（69.0）		27.10±1.45		2.01±0.36		10.48±1.76
t或χ²			1.231		0.244		0.478		0.765		0.001		0.374		0.642		19.666^＊＊
组别	FBG/（mmol/L）			HOMA-IR		HDL-C/（mmol/L）		LDL-C/（mmol/L）		TG/（mmol/L）		TC/（mmol/L）		HbA1c/%		Alarin/（mg/L）		Ficolin-3/（μg/L）
对照组	4.12±0.69			1.72±0.55		1.36±0.30		2.50±0.69		2.36±0.80		4.95±0.94		3.77±0.72		0.21±0.06		20.55±6.05
GDM组	6.51±0.83			3.60±0.71		1.38±0.35		2.53±0.79		2.41±0.76		5.13±1.16		6.00±1.14		0.42±0.14		32.28±10.42
t或χ²	25.364^＊＊			24.249^＊＊		0.501		0.329		0.515		1.388		18.838^＊＊		16.350^＊＊		11.103^＊＊

指标	HbA1c	Alarin	Ficolin-3
2 h PG	0.490^＊＊	0.491^＊＊	0.524^＊＊
FBG	0.516^＊＊	0.503^＊＊	0.519^＊＊
HOMA-IR	0.525^＊＊	0.496^＊＊	0.529^＊＊

指标	HbA1c	Alarin	Ficolin-3
2 h PG	0.490^＊＊	0.491^＊＊	0.524^＊＊
FBG	0.516^＊＊	0.503^＊＊	0.519^＊＊
HOMA-IR	0.525^＊＊	0.496^＊＊	0.529^＊＊

血糖控制情况	n	HbA1c/%	Alarin/（mg/L）	Ficolin-3/（μg/L）
血糖控制好	71	5.39±0.68	0.35±0.09	28.06±8.24
血糖控制差	58	6.74±1.15	0.50±0.14	37.44±10.53
t		7.899^＊＊	7.238^＊＊	5.535^＊＊

血清HbA1c、Alarin及Ficolin-3水平对妊娠期糖尿病患者妊娠结局的预测价值

Clinical value of serum HbA1c, Alarin and Ficolin-3 levels in predicting pregnancy outcome in patients with gestational diabetes mellitus

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妊娠结局	n	HbA1c/%	Alarin/（mg/L）	Ficolin-3/（μg/L）
无不良妊娠结局	91	5.57±0.82	0.36±0.10	28.97±9.01
不良妊娠结局	38	7.04±1.16	0.55±0.13	40.18±9.32
t		7.121^＊＊	7.958^＊＊	6.373^＊＊

变量	B	SE	Wald χ²	P	OR（95%CI）
HbA1c	1.768	0.460	14.743	<0.001	5.857（2.376~14.440）
Alarin	17.690	4.432	15.934	<0.001	4.816×10⁷（8.135× 10³~2.850×10¹¹）
Ficolin-3	0.156	0.049	10.061	0.002	1.169（1.061~1.287）
常数项	-25.294	5.036	25.223	<0.001	0.000

指标	AUC（95%CI）	截断值	敏感度/%	特异度/%
HbA1c	0.840（0.754~0.927）	5.90%	60.58	96.75
Alarin	0.865（0.795~0.935）	0.45 mg/L	73.74	85.74
Ficolin-3	0.815（0.734~0.897）	34.05 μg/L	71.13	87.91
联合	0.979（0.960~0.998）		97.43	84.64

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