妊娠前三酰甘油/高密度脂蛋白胆固醇值联合胱抑素C预测妊娠期糖尿病的价值

史晓娟; 李东风; 张小伟

doi:10.16766/j.cnki.issn.1674-4152.003381

妊娠前三酰甘油/高密度脂蛋白胆固醇值联合胱抑素C预测妊娠期糖尿病的价值

doi: 10.16766/j.cnki.issn.1674-4152.003381

1.
皖西卫生职业学院附属医院护理部，安徽六安 237008
2.
皖西卫生职业学院附属医院内分泌科
3.
皖西卫生职业学院附属医院妇产科

基金项目:

安徽省教育厅人文社会科学研究重点项目 SK2020A0722

安徽省教育厅自然科学研究重点项目 KJ2021A1367

详细信息

通讯作者:
李东风，E-mail：lawxldf@163.com

中图分类号: R714.256 R446
计量
- 文章访问数: 274
- HTML全文浏览量: 137
- PDF下载量: 19
- 被引次数: 0
出版历程
- 收稿日期: 2023-03-21
- 网络出版日期: 2024-03-27

Predictive value of pregestational TG/HDL-C ratio combined with cystatin C in predicting gestational diabetes in pregnant women

1.
Nursing Department, Affiliated Hospital of West Anhui Health Vocational College, Lu'an, Anhui 237008, China

摘要

摘要: 目的分析妊娠前妇女血清三酰甘油/高密度脂蛋白胆固醇值(TG/HDL-C)、胱抑素C(Cys-C)水平及其与胰岛素抵抗的关系，探讨TG/HDL-C及胱抑素C水平与妊娠期糖尿病(GDM)的相关性。方法选取2020年1月—2022年6月在皖西卫生职业学院附属医院就诊的孕产妇198例为研究对象，按照是否发生GDM分为观察组(发生GDM)98例与对照组(未发生GDM)100例。收集2组研究对象的一般临床资料，并分析其与GDM的关系。结果 2组妇女学历、家庭经济、饮食控制、运动量、吸烟史、饮酒史、腰围、SBP、DBP、空腹血糖(FPG)、ALT、AST、肌酐(Cr)、尿酸(UA)、TC、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)差异均无统计学意义(P>0.05)，而年龄、BMI、Cys-C、TG、TG/HDL-C值差异均有统计学意义(P < 0.05)；Logistic回归分析显示，高年龄、高水平的血清Cys-C及高水平的TG/HDL-C值均为GDM发生的独立危险因素(P < 0.05)，OR值分别为1.111、3.190和3.970。ROC曲线分析结果显示TG/HDL-C值和Cys-C曲线下面积(AUC)分别为0.820(P < 0.001)和0.667(P < 0.001)；两者联合检测的AUC值为0.848(P < 0.001)，诊断效能优于单项检测。结论妊娠前血清TG/HDL-C值和Cys-C水平高的女性更容易发生GDM，该两项指标有望用于备孕期女性发生GDM的风险评估和预测。
- 三酰甘油/高密度脂蛋白胆固醇值 /
- 胱抑素C /
- 妊娠期糖尿病 /
- 胰岛素抵抗
Abstract: Objective This study aims to examine the association between the triglycerides to HDL cholesterol(TG/HDL-C), cystatin C levels, and insulin resistance in pre-pregnancy women. Additionally, it seeks to investigate the correlation between TG/HDL-C and cystatin C with gestational diabetes mellitus (GDM). Methods A total of 198 pregnant women at the Affiliated Hospital of West Anhui Health Vocational College from January 2020 to June 2022 were selected as the research objects. They were divided into two groups: the observation group (98 cases with GDM) and the control group (100 cases without GDM). General clinical data from both groups were collected and analyzed to explore the relationship between these data and GDM. Results There were no significant difference in education, family economic situation, diet control, exercise, smoking history, drinking history, waist circumference, SBP, DBP, FPG, ALT, AST, Cr, UA, TC, HDL-C, and LDL-C between the two groups (P>0.05). However, but there were significant difference in age, BMI, Cys-C, and LDL-C. Logistic regression analysis showed that advanced age, elevated serum Cys-C, and increased TG/HDL-C ratio were independent risk factors for GDM (P < 0.05), with corresponding OR of 1.111, 3.190 and 3.970 respectively. ROC curve analysis demonstrated that TG/HDL-C ratio had an area under the Cys-C curve (AUC) of 0.820 (P < 0.001), while Cys-C had an AUC of 0.667 (P < 0.001). The combined detection of both parameters yielded an AUC of 0.848(P < 0.001), indicating better diagnostic efficiency compared to individual tests. Conclusion Pregnant women with high serum TG/HDL-C ratio and Cys-C levels prior to pregnancy are at a higher risk of GDM. These two indicators hold promise for risk assessment and prediction of GDM in pregnant women.
- TG/HDL-C ratio /
- Cystatin C /
- Gestational diabetes mellitus /
- Insulin resistance

HTML全文

图 1 年龄、血清Cys-C水平及TG/HDL-C值单独预测GDM的ROC曲线

Figure 1. ROC curve of GDM predicted by age, serum Cys-C level and TG/HDL-C ratio alone

下载: 全尺寸图片幻灯片

图 2 TG/HDL-C值与血清Cys-C水平联合检测GDM的ROC曲线

Figure 2. ROC curve of GDM detected by combination of TG/HDL-C ratio and serum Cys-C level

下载: 全尺寸图片幻灯片

表 1 2组孕产妇的一般临床资料比较

Table 1. Comparison of the general clinical data between two groups of pregnant women

项目	观察组(n=98)	对照组(n=100)	统计量	P值
年龄(x±s, 岁)	27.85±3.89	26.73±3.86	2.029^a	0.044
学历[例(%)]			-1.152^b	0.249
小学	8(8.16)	12(12.00)
中学	49(50.00)	53(53.00)
大学及以上	41(41.84)	35(35.00)
家庭经济好[例(%)]	55(56.12)	60(60.00)	0.306^c	0.580
饮食控制好[例(%)]	34(34.69)	41(41.00)	0.836^c	0.360
运动量多[例(%)]	34(34.69)	46(46.00)	2.628^c	0.105
有吸烟史[例(%)]	14(14.29)	13(13.00)	-0.069^c	0.792
有饮酒史[例(%)]	21(21.43)	25(25.00)	0.354^c	0.552
腰围(x±s, cm)	76.78±5.12	75.24±6.39	1.865^a	0.064
BMI(x±s)	22.96±2.31	22.30±1.88	2.207^a	0.029
SBP(x±s, mmHg)	121.02±9.62	120.30±8.62	0.555^a	0.579
DBP(x±s，mmHg)	67.91±5.68	68.34±5.64	-0.537^a	0.592
FPG(x±s，mmol/L)	5.01±0.48	4.92±0.45	1.295^a	0.197
ALT(x±s，U/L)	17.62±5.63	18.76±5.49	-1.443^a	0.151
AST(x±s，U/L)	20.49±5.89	21.29±6.06	-0.947^a	0.345
Cr(x±s，μmol/L)	63.08±13.78	64.83±15.01	-0.850^a	0.396
UA(x±s，μmol/L)	301.62±80.24	308.47±79.04	-0.606^a	0.545
Cys-C(x±s，mg/L)	1.55±0.48	1.30±0.38	4.164^a	< 0.001
TC(x±s，mmol/L)	4.21±0.69	4.15±0.63	0.605^a	0.546
TG(x±s，mmol/L)	2.52±1.06	1.51±0.54	8.471^a	< 0.001
HDL-C(x±s，mmol/L)	1.01±0.34	1.09±0.35	-1.743^a	0.083
LDL-C(x±s，mmol/L)	2.72±0.77	2.58±0.56	1.419^a	0.158
TG/HDL-C值(x±s)	2.69±1.21	1.44±0.48	9.522^a	< 0.001
注：^a为t值，^b为Z值，c为χ²值。1 mmHg=0.133 kPa。

下载: 导出CSV

表 2 2组孕产妇发生GDM影响因素的logistic回归分析

Table 2. Logistic regression analysis of influencing factors for GDM in two groups of pregnant women

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	0.105	0.052	4.146	0.042	1.111	1.004~1.230
BMI	0.159	0.093	2.914	0.088	1.173	0.977~1.408
Cys-C	1.160	0.473	6.010	0.014	3.190	1.262~8.066
TG	0.587	0.418	1.970	0.160	1.798	0.792~4.080
TG/HDL-C值	1.379	0.381	13.093	< 0.001	3.970	1.881~8.377

下载: 导出CSV

表 3 年龄、血清Cys-C水平及TG/HDL-C单独及联合预测GDM的ROC曲线分析

Table 3. ROC curve analysis for predicting GDM by age, serum Cys-C levels, and TG/HDL-C alone and in combination

变量	AUC	95%CI	P值
TG/HDL-C值	0.820	0.758~0.883	< 0.001
Cys-C	0.667	0.592~0.742	< 0.001
年龄	0.588	0.508~0.667	0.033
联合预测概率	0.848	0.793~0.904	< 0.001

下载: 导出CSV

参考文献(20)

[1]	SWEETING A, WONG J, MURPHY H R, et al. A clinical update on gestational diabetes mellitus[J]. Endocr Rev, 2022, 43(5): 763-793. doi: 10.1210/endrev/bnac003
[2]	SUN H, SAEEDI P, KARURANGA S, et al. IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045[J]. Diabetes Res Clin Pract, 2022, 183: 109119. DOI: 10.1016/j.diabres.2021.109119.
[3]	SAEEDI P, PETERSOHN I, SALPEA P, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition[J]. Diabetes Res Clin Pract, 2019, 157: 107843. DOI: 10.1016/j.diabres.2019.107843.
[4]	SERT U Y, OZGU-ERDINC A S. Gestational diabetes mellitus screening and diagnosis[J]. Adv Exp Med Biol, 2021, 1307: 231-255.
[5]	中华医学会妇产科学分会产科学组, 中华医学会围产医学分会, 中国妇幼保健协会妊娠合并糖尿病专业委员会, 等. 妊娠期高血糖诊治指南(2022)[第一部分][J]. 中华妇产科杂志, 2022, 57(1): 3-12. Obstetrics Group of Obstetrics and Gynecology Branch of Chinese Medical Association, Perinatal Medicine Branch of Chinese Medical Association, Professional Committee of Pregnancy Complicated with Diabetes of China Maternal and Child Health Association, et al. Guideline of diagnosis and treatment of hyperglycemia in pregnancy(2022)[Part one][J]. Chinese Journal of Obstetrics and Gynecology, 2022, 57(1): 3-12.
[6]	WEI Y L, HE A D, TANG C P, et al. Risk prediction models of gestational diabetes mellitus before 16 gestational weeks[J]. BMC Pregnancy Childbirth, 2022, 22(1): 889. doi: 10.1186/s12884-022-05219-4
[7]	WAKABAYASHI I, DAIMON T. Comparison of discrimination for cardio-metabolic risk by different cut-off values of the ratio of triglycerides to HDL cholesterol[J]. Lipids Health Dis, 2019, 18(1): 156-165. doi: 10.1186/s12944-019-1098-0
[8]	JIN H. Increased levels of glycosylated hemoglobin, microalbuminuria and serum cystatin C predict adverse outcomes in high-risk pregnancies with gestational diabetes mellitus[J]. Exp Ther Med, 2020, 19(2): 1281-1287.
[9]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021, 13(4): 315-409. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYX202112018.htm Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition)[J]. Chinese Journal of Diabetes Mellitus, 2021, 13(4): 315-409. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYX202112018.htm
[10]	BORIBOONHIRUNSARN D, SUNSANEEVITHAYAKUL P, PANNIN C, et al. Prevalence of early-onset GDM and associated risk factors in a university hospital in Thailand[J]. J Obstet Gynaecol, 2021, 41(6): 915-919. doi: 10.1080/01443615.2020.1820469
[11]	LIN L, WANG X Y, ZHAO W H, et al. Upregulation of Klotho aggravates insulin resistance in gestational diabetes mellitus trophoblast cells[J]. Genet Res (Camb), 2022: 1500768. DOI: 10.1155/2022/1500768.
[12]	LIU X L, WANG N, GAO Z. β-Carotene regulates glucose transport and insulin resistance in gestational diabetes mellitus by increasing the expression of SHBG. [J]. Clin Exp Pharmacol Physiol, 2022, 49(12): 1307-1318. doi: 10.1111/1440-1681.13712
[13]	赵林芳, 陈丹丹. 妊娠期甲状腺功能、糖脂代谢变化及增重与妊娠期糖尿病发生风险关系[J]. 中国计划生育学杂志, 2023, 31(7): 1727-1731. https://www.cnki.com.cn/Article/CJFDTOTAL-JHSY202307039.htm ZHAO L F, CHEN D D. Correlation between the hypothyroidism, metabolic changes, and weight gain of pregnant women and their risk of gestational diabetes mellitus occurrence[J]. Chinese Journal of Family Planning, 2023, 31(7): 1727-1731. https://www.cnki.com.cn/Article/CJFDTOTAL-JHSY202307039.htm
[14]	YONG H Y, SHARIFF Z M, YUSOF B, et al. Independent and combined effects of age, body mass index and gestational weight gain on the risk of gestational diabetes mellitus[J]. Sci Rep, 2020, 10(1): 84-86. doi: 10.1038/s41598-019-56962-2
[15]	孟耀涵, 曲翌敏, 湛永乐, 等. 妊娠糖尿病的影响因素及围产期结局[J]. 中华疾病控制杂志, 2022, 26(9): 1011-1016. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ202209005.htm MENG Y H, QU Y M, ZHAN Y L, et al. The influencing factors and perinatal outcomes of gestational diabetes[J]. Chinese Journal of Disease Control & Prevention, 2022, 26(9): 1011-1016. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ202209005.htm
[16]	骆长江, 李明珠. 孕早期血清P-LAP、NSF-1水平预测妊娠期糖尿病价值[J]. 中国计划生育学杂志, 2023, 31(7): 1703-1707. https://www.cnki.com.cn/Article/CJFDTOTAL-JHSY202307036.htm LUO C J, LI M Z. Predictive value of the serum placental leucine aminopeptidase and nesfatin 1levels of pregnant women during the first trimester of pregnancy for their gestational diabetes mellitus[J]. Chinese Journal of Family Planning, 2023, 31(7): 1703-1707. https://www.cnki.com.cn/Article/CJFDTOTAL-JHSY202307036.htm
[17]	叶瑛瑛, 王金辉, 王丽君, 等. 孕妇血维生素D水平与妊娠期糖尿病相关性研究[J]. 中华全科医学, 2021, 19(1): 77-79, 119. doi: 10.16766/j.cnki.issn.1674-4152.001735 YE Y Y, WANG J H, WANG L J, et al. Study on the relationship between serum vitamin D level and gestational diabetes mellitus in pregnant women[J]. Chinese Journal of General Practice, 2021, 19(1): 77-79, 119. doi: 10.16766/j.cnki.issn.1674-4152.001735
[18]	LIU P, WANG Z H, KANG S S, et al. High-fat diet-induced diabetes couples to Alzheimer's disease through inflammation-activated C/EBPβ/AEP pathway[J]. Mol Psychiatry, 2022, 27(8): 3396-3409. doi: 10.1038/s41380-022-01600-z
[19]	楼公先, 楼时先, 程秒鸳, 等. 孕早期FBG、HbA1c、TC、TG联合检测在妊娠期糖尿病诊断中的应用价值分析[J]. 中华全科医学, 2019, 17(5): 809-812. doi: 10.16766/j.cnki.issn.1674-4152.000798 LOU X G, LOU S X, CHENG M Y, et al. Analysis of the application value combined detection of FBG, HbA1c, TC and TG in diagnosis of GDM in early pregnancy[J]. Chinese Journal of General Practice, 2019, 17(5): 809-812. doi: 10.16766/j.cnki.issn.1674-4152.000798
[20]	YOUNG K A, MATURU A, LORENZO C, et al. The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio as a predictor of insulin resistance, β-cell function, and diabetes in Hispanics and African Americans[J]. J Diabetes Complications, 2019, 33(2): 118-122. doi: 10.1016/j.jdiacomp.2018.10.018