| 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75g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。 |
| 关键词: 分泌型卷曲相关蛋白 5 妊娠糖尿病 早期诊断 |
| DOI：10.12056/j.issn.1006-2785.2017.39.20.2017-873 |
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| 基金项目: |
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| Prediction value of first trimester serum Sfrp-5 level for gestational diabetes mellitus |
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Wuxi Maternity and Child Care Hosptial
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| Abstract: |
| 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 △I30/△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. Results 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. |
| Key words: Secreted frizzle-related protein-5 Gestational diabetes mellitus Early diagnosis |
