妊娠中晚期孕妇血清Gremlin1水平变化及其对妊娠期糖尿病的影响

doi:10.3969/j.issn.1004-583X.2022.03.011

摘要/Abstract

摘要：

目的了解妊娠中晚期孕妇血清Gremlin1水平变化,探究Gremlin1对妊娠期糖尿病(gestational diabetes mellitus,GDM)的影响。方法选取2020年9-11月就诊于安徽医科大学第一附属医院行孕期体检的妊娠24~28周并完善口服葡萄糖耐量试验(oral glucose tolerance test, OGTT)的妊娠期女性175例为研究对象,根据OGTT结果分为GDM组和糖代谢正常组(NGT组)。收集两组临床资料,包括一般资料、Gremlin1水平及其他生化指标,比较两组临床资料的差异。结果 GDM组妊娠前体重、妊娠后体重、妊娠前体质量指数(body mass index,BMI)、妊娠后BMI、空腹血糖(fasting blood glouse,FBG)、1 h血糖(1 h blood glouse,1 hBG)、2 h血糖(2 h blood glouse, 2 hBG)、空腹胰岛素(fasting insulin,FINS)、1 h胰岛素(1 h insulin, 1 hINS)、2 h胰岛素(2 h insulin, 2 hINS)、空腹C肽(fasting C protein,FCP)、1 h C肽(1 h C protein,1 hCP)、2 h C肽(2 h C protein, 2 hCP)、胰岛素抵抗指数 (homeostatic model assessment insulin resistance, HOMA-IR)、血糖曲线下面积(AUC-G)、胰岛素曲线下面积(AUC-I)高于NGT组,胰岛β细胞功能指数(homeostatic model assessment βcell insulin secretion index, HOMA-β)、胰岛素敏感指数(insulin sensitivity index,ISI)低于NGT组(均P<0.05)。GDM组血清Gremlin1水平高于NGT组(P<0.05)。Pearson相关分析提示血清Gremlin1水平与妊娠后BMI、FBG、1 hBG、1 hINS、2 hBG、2 hINS、2 hCP、HOMA-IR、 AUG-G、AUC-I呈正相关,与HOMA-β、ISI呈负相关(均P<0.05)。多因素Logistic回归分析提示,血清Gremlin1是GDM的独立危险因素(OR=8.922,95%CI 1.863~42.736,P<0.05)。结论 GDM患者血清Gremlin1升高,并与胰岛素抵抗呈正相关,参与GDM的糖代谢。

关键词: 糖尿病,妊娠, 胰岛素抵抗, Gremlin1

Abstract:

Objective To explore the changes of serum Gremlin1 level in pregnant women in the second and third trimester of pregnancy and its relation with gestational diabetes mellitus (GDM). Methods From September to November 2020, a total of 175 pregnant women received pregnancy test in the First Affiliated Hospital of Anhui Medical University were enrolled, the patients had finished the oral glucose tolerance test (OGTT) during 24 to 28 weeks of pregnancy. They were divided into GDM group and normal glucose metabolism group (NGT group) by the OGTT results. The interclass clinical data including general data, Gremlin1 level and other biochemical indicators were collected, the differences of clinical data between the two groups were analyzed. Results The pre- and post-pregnancy body weight, pre-pregnancy body mass index (BMI), post-pregnancy BMI, fasting blood glucose (FBG), 1 h blood glucose (1 hBG), 2 h blood glucose (2 hBG), fasting insulin (FINS), 1 h insulin (1 hINS), 2 h insulin (2 hINS), fasting C protein (FCP), 1 h C peptide (1 hCP), 2 h C peptide (2 hCP), homeostasis model assessment of insulin resistance (HOMA-IR), area under curve of glucose (AUC-G), area under the curve for insulin (AUC-I) were higher in GDM group than in NGT group; homeostasis model assessment for beta-cell function index (HOMA-β) and insulin sensitivity index (ISI) in GDM group were lower than those in NGT group (all P<0.05). Serum Gremlin1 level in GDM group was higher than that in NGT group (P<0.05). Pearson correlation analysis showed that serum Gremlin1 level was positively correlated with post-pregnancy BMI, FBG, 1 hBG, 1 hINS, 2 hBG, 2 hINS, 2 hCP, HOMA-IR, AUG-G, AUC-I, and negatively correlated with HOMA-β, ISI (all P<0.05). Multivariate Logistic regression analysis showed that the independent risk factor for GDM was serum Gremlin1 (OR=8.922, 95%CI 1.863-42.736, P<0.05). Conclusion There is a positively correlated between increased serum Gremlin1 with insulin resistance in GDM patients, participating in the glucose metabolism of GDM.

Key words: diabetes,gestational, insulin resistance, Gremlin1

中图分类号:

R714.256

齐琪, 江黎晨, 孙蓉, 胡红琳, 章秋. 妊娠中晚期孕妇血清Gremlin1水平变化及其对妊娠期糖尿病的影响[J]. 临床荟萃, 2022, 37(3): 257-261.

Qi Qi, Jiang Lichen, Sun Rong, Hu Honglin, Zhang Qiu. Changes of serum Gremlin1 level in pregnant women in the second and third trimester of pregnancy and its relation with gestational diabetes mellitus[J]. Clinical Focus, 2022, 37(3): 257-261.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.03.011

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I3/257

图/表 5

参考文献 17

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组别	例数	年龄 (岁)	孕周 (周)	身高 (cm)	妊娠前体重 (kg)	妊娠后体重 (kg)	妊娠前BMI (kg/m²)	妊娠后BMI (kg/m²)	妊娠期增加体重(kg)
NGT组	88	29.73±4.04	24.90±1.37	161.96±4.32	53.67±7.76	61.08±8.09	20.45±2.79	23.27±2.81	7.41±3.39
GDM组	87	30.72±4.17	24.75±1.42	160.79±5.13	57.66±9.57	65.07±9.47	22.27±3.32	25.13±3.15	7.41±3.29
t值		1.606	-0.714	-1.637	3.033	3.004	3.930	4.132	0.009
P值		0.110	0.476	0.103	<0.05	<0.05	<0.05	<0.05	0.993

组别	例数	年龄 (岁)	孕周 (周)	身高 (cm)	妊娠前体重 (kg)	妊娠后体重 (kg)	妊娠前BMI (kg/m²)	妊娠后BMI (kg/m²)	妊娠期增加体重(kg)
NGT组	88	29.73±4.04	24.90±1.37	161.96±4.32	53.67±7.76	61.08±8.09	20.45±2.79	23.27±2.81	7.41±3.39
GDM组	87	30.72±4.17	24.75±1.42	160.79±5.13	57.66±9.57	65.07±9.47	22.27±3.32	25.13±3.15	7.41±3.29
t值		1.606	-0.714	-1.637	3.033	3.004	3.930	4.132	0.009
P值		0.110	0.476	0.103	<0.05	<0.05	<0.05	<0.05	0.993

组别	例数		FBG (mmol/l)		FINS (mU/L)		FCP (μg/L)		1 hBG (mmol/L)		1 hINS (mU/L)		1 hCP (μg/L)		2 hBG (mmol/L)		2 hINS (mU/L)
NGT组	88		4.62±0.26		8.65±3.70		1.03±0.29		7.09±1.33		69.22±40.62		5.69±2.03		6.44±1.09		63.93±37.92
GDM组	87		5.27±0.53		11.65±4.83		1.34±0.63		9.52±1.84		92.81±49.76		6.46±2.23		8.13±1.48		95.37±55.29
t值			10.346		4.618		4.188		10.049		3.437		2.405		8.566		4.391
P值			0.000		0.000		0.000		0.000		0.001		0.017		0.000		0.000
组别		例数		2 hCP (μg/L)		HOMA-IR		HOMA-β		ISI		AUG-G		AUC-I		Gremlin1
NGT组		88		5.49±2.15		1.79±0.82		159.35±66.48		0.03±0.01		12.62±1.73		55.08±5.87		4.54±0.71
GDM组		87		7.29±3.11		2.76±1.25		138.48±60.16		0.02±0.01		16.22±2.38		146.32±73.93		5.33±0.80
t值				4.458		6.117		-2.176		-4.926		11.458		4.144		6.950
P值				0.000		0.000		0.031		0.000		0.000		0.000		0.000

组别	例数		FBG (mmol/l)		FINS (mU/L)		FCP (μg/L)		1 hBG (mmol/L)		1 hINS (mU/L)		1 hCP (μg/L)		2 hBG (mmol/L)		2 hINS (mU/L)
NGT组	88		4.62±0.26		8.65±3.70		1.03±0.29		7.09±1.33		69.22±40.62		5.69±2.03		6.44±1.09		63.93±37.92
GDM组	87		5.27±0.53		11.65±4.83		1.34±0.63		9.52±1.84		92.81±49.76		6.46±2.23		8.13±1.48		95.37±55.29
t值			10.346		4.618		4.188		10.049		3.437		2.405		8.566		4.391
P值			0.000		0.000		0.000		0.000		0.001		0.017		0.000		0.000
组别		例数		2 hCP (μg/L)		HOMA-IR		HOMA-β		ISI		AUG-G		AUC-I		Gremlin1
NGT组		88		5.49±2.15		1.79±0.82		159.35±66.48		0.03±0.01		12.62±1.73		55.08±5.87		4.54±0.71
GDM组		87		7.29±3.11		2.76±1.25		138.48±60.16		0.02±0.01		16.22±2.38		146.32±73.93		5.33±0.80
t值				4.458		6.117		-2.176		-4.926		11.458		4.144		6.950
P值				0.000		0.000		0.031		0.000		0.000		0.000		0.000

	年龄	孕周	身高	妊娠后体重	妊娠前体重	妊娠后 BMI	妊娠前 BMI	妊娠期增加体重	FBG	FINS	FCP
r值	-0.005	0.068	-0.138	0.1	0.05	0.168	0.105	0.136	0.369	0.127	0.032
P值	0.949	0.375	0.069	0.188	0.511	<0.05	0.168	0.072	<0.05	0.095	0.678
	1 hBG	1 hINS	1 hCP	2 hBG	2 hINS	2 hCP	HOMA-IR	HOMA-β	ISI	AUG-G	AUC-I
r值	0.321	0.209	0.139	0.274	0.215	0.220	0.191	-0.143	-0.200	0.347	0.226
P值	<0.05	<0.05	0.066	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05