目的：探讨血清Sortilin水平诊断妊娠期糖尿病（GDM）的价值,分析其与糖脂代谢、胰岛素抵抗的相关性。方法：选取2019年2月―2022年2月我院产科门诊接诊的911例孕妇为研究对象,其中162例为GDM孕妇（GDM组）,749例为糖耐量正常孕妇（对照组）。妊娠12周、妊娠20周、妊娠28周检测血清Sortilin水平,妊娠28周检测糖脂代谢以及胰岛素抵抗状态。分析Sortilin与糖脂代谢、胰岛素抵抗的相关性,GDM患病的危险因素以及Sortilin诊断GDM的价值。结果：GDM组年龄、孕前体质量指数、孕期体质量增长、血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白B（Apo-B）、空腹血糖（FPG）、空腹胰岛素（FINS）水平及胰岛素抵抗指数（HOMA-IR）高于对照组。GDM组妊娠12周至28周血清Sortilin水平逐渐增高,对照组无明显变化,GDM组妊娠12周、妊娠20周、妊娠28周血清Sortilin水平均高于对照组。GDM患者妊娠12周、妊娠20周、妊娠28周血清Sortilin水平与TC、TG、LDL-C、Apo-B、FPG、FINS、HOMA-IR呈正相关。高孕期体质量增长、妊娠20周Sortilin、HOMA-IR是GDM的危险因素。妊娠12周、妊娠20周Sortilin预测GDM的临界值为139.65 pg/mL、145.07 pg/mL,曲线下面积为0.754（95%CI：0.725~0.782）、0.807（95%CI：0.779~0.832）,灵敏度为77.78%、80.86%,特异度为69.83%、79.97%,约登指数为0.4760、0.6084。结论：GDM患者妊娠早期血清Sortilin水平即出现增高,且与糖脂代谢紊乱以及胰岛素抵抗有关,妊娠早期血清Sortilin可作为GDM预测的标志物。
Abstract
Objective To investigate the diagnostic value of serum Sortilin level in gestational diabetes mellitus (GDM) and analyze its correlation with glucose and lipid metabolism and insulin resistance. Methods 911 pregnant women admitted to the obstetrical clinic of our hospital from February 2019 to February 2022 were selected as the study subjects, including 162 pregnant women with GDM (GDM group) and 749 pregnant women with normal glucose tolerance (control group). Serum Sortilin level were detected at gestation week 12, and week 20, 28 , glucose and lipid metabolism and insulin resistance were detected. The correlation between Sortilin and glucose and lipid metabolism, insulin resistance and the diagnostic value of Sortilin in GDM were analyzed. Results Age, pre-pregnancy body mass index, pregnancy body weight gain, serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo-B), fasting blood glucose (FPG), fasting insulin (FINS) level and insulin resistance index (HOMA-I) in GDM group were higher than that of control group. The serum Sortilin level of GDM group increased gradually from week 12 to week 28 of gestation, but had no significant change in the control group. The serum Sortilin level of GDM group at week 12, week 20 and week 28 of gestation was higher than that of the control group. Serum Sortilin level at gestation week 12, and week 20, 28 was positively correlated with TC, TG, LDL-C, APO-B, FPG, FINS, HOMA-IR. High pregnancy body weight gain, Sortilin at gestation week 20 and week 28 and HOMA-IR were risk factors for GDM. The area under the curve of Sortilin at gestation week 12 and week 20 in diagnosing GDM was 0.754(95%CI: 0.725-0.782), 0.807(95%CI: 0.779―0.832), with sensitivity of 77.78% and 80.86%, specificity of 69.83% and 79.97%. Conclusion Serum Sortilin level in GDM patients increases in the first trimester of pregnancy, which is related to glucose and lipid metabolism disorders and insulin resistance. Serum Sortilin level in the first trimester of pregnancy can be used as a predictive marker of GDM.
关键词
妊娠期糖尿病 /
糖脂代谢 /
胰岛素抵抗 /
Sortilin
Key words
gestational diabetes mellitus /
glucolipid metabolism /
insulin resistance /
sortilin
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基金
重庆市卫生计生委医学科研计划面上项目（2019MSXM05646）
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