目的：探究磷脂酰肌醇3-激酶（PI3K）/丝氨酸苏氨酸蛋白激酶（AKT）信号通路相关因子与妊娠期妇女糖耐量异常、胰岛素抵抗相关性。方法：选取2020年3月―2022年3月我院75例妊娠期糖耐量异常孕妇作为研究组,另选同期75例糖耐量正常孕妇作为对照组。比较两组临床资料、PI3K/AKT信号通路标志因子[PI3K、磷酸化AKT（p-AKT）]、空腹血糖（FPG）、胰岛素抵抗指数（Homa - insulin resistance,HOMA-IR）,通过交互作用分析PI3K、p-AKT对妊娠期妇女糖耐量异常的影响,采用Pearson相关系数分析PI3K、p-AKT水平与妊娠期糖耐量异常孕妇FPG、HOMA-IR的相关性。比较研究组单纯糖耐量异常孕妇、妊娠期糖尿病（GDM）孕妇临床资料及血清PI3K、p-AKT、FPG水平及HOMA-IR,通过Logistic多因素回归模型分析GDM的影响因素,采用受试者工作特征（ROC）曲线分析血清PI3K、p-AKT水平预测GDM的价值。结果：研究组血清PI3K水平低于对照组,血清p-AKT、FPG水平及HOMA-IR高于对照组;PI3K低水平与p-AKT高水平在妊娠期妇女糖耐量异常中呈超相乘模型的正向交互作用;妊娠期糖耐量异常孕妇血清PI3K水平与FPG、HOMA-IR呈负相关,p-AKT水平与FPG、HOMA-IR呈正相关;GDM孕妇体重指数、糖尿病家族史占比、血清p-AKT、FPG水平及HOMA-IR高于单纯糖耐量异常孕妇,血清PI3K水平低于单纯糖耐量异常孕妇;体重指数、糖尿病家族史、血清PI3K、p-AKT水平均为GDM的影响因素;血清PI3K、p-AKT水平预测GDM的曲线下面积（AUC）均>0.7,二者联合预测的AUC最大,为0.916,预测敏感度、特异度分别为90.62%、80.13%。结论：PI3K/AKT信号通路标志因子PI3K、p-AKT水平变化与妊娠期妇女糖耐量异常、胰岛素抵抗密切相关,二者联合在预测GDM方面具有良好预测效能。
Abstract
Objective To investigate the correlation between factors related to the phosphatidylinositol 3-kinase (PI3K) /serine threonine protein kinase (AKT) signaling pathway and abnormal glucose tolerance and insulin resistance in women during pregnancy. Methods Seventy-five pregnant women with abnormal glucose tolerance during pregnancy in our hospital from March 2020 to March 2022 were selected as the study group, and another 75 pregnant women with normal glucose tolerance during the same period were selected as the control group. The clinical data, PI3K/AKT signaling pathway markers [PI3K, phosphorylated AKT (p-AKT) ], fasting blood glucose (FPG), insulin resistance index (Homa - insulin resistance, HOMA-IR) were compared between the two groups, and the effects of PI3K and p-AKT on abnormal glucose tolerance in women during pregnancy were analyzed by interaction. Pearson correlation coefficient was used to analyze the correlation between PI3K and p-AKT levels and FPG and HOMA-IR in pregnant women with abnormal glucose tolerance during pregnancy. The clinical data and serum PI3K, p-AKT, FPG levels and HOMA-IR of pregnant women with simple glucose tolerance abnormalities and pregnant women with gestational diabetes mellitus (GDM) in the study group were compared, and the factors influencing GDM were analyzed by logistic multi-factor regression model, and the value of serum PI3K and p-AKT levels in predicting GDM was analyzed by subject work characteristic (ROC) curve. RESULTS: Serum PI3K levels were lower in the study group than in the control group, and serum p-AKT, FPG levels and HOMA-IR were higher than in the control group; low PI3K levels and high p-AKT levels showed a positive interaction in a superphase multiplicative model of glucose tolerance abnormalities in pregnant women; serum PI3K levels in pregnant women with glucose tolerance abnormalities in pregnancy were negatively correlated with FPG, HOMA-IR, and p-AKT levels were negatively correlated with FPG and HOMA-IR. Body mass index, family history of diabetes, serum p-AKT, FPG levels and HOMA-IR were higher in pregnant women with GDM than in pregnant women with simple glucose tolerance abnormalities, and serum PI3K levels were lower than in pregnant women with simple glucose tolerance abnormalities; body mass index, family history of diabetes, serum PI3K and p-AKT levels were all influencing factors for GDM; serum The area under the curve (AUC) for the prediction of GDM by serum PI3K and p-AKT levels were all>0.7, and the AUC for the combined prediction of the two was the largest at 0.916, and the sensitivity and specificity of the prediction were 90.62% and 80.13%, respectively. Conclusion Changes in the levels of PI3K and p-AKT, markers of PI3K/AKT signaling pathway, are closely associated with abnormal glucose tolerance and insulin resistance in women during pregnancy, and their combination has good predictive efficacy in predicting GDM.
关键词
妊娠期 /
糖耐量异常 /
胰岛素抵抗 /
PI3K/AKT信号通路 /
妊娠期糖尿病
Key words
gestation /
abnormal glucose tolerance /
insulin resistance /
PI3K/AKT signaling pathway /
gestational diabetes mellitus
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