Abstract:

Objective　To study and analyze the correlation of the serum levels of insulin receptor substrate-1 (IRS-1) and C1q tumor necrosis factor related protein-3 (CTRP-3) with adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM). Methods　From January 2021 to December 2023, 132 women with GDM who gave birth at Second Hospital, Shaanxi University of Chinese Medicine were selected as a diseased group; they were (28.76±3.18) years old; their body mass index (BMI) was (25.72±2.82) kg/m²; their gestation weeks was (38.06±1.42); among them, there were 66 multiparae; 82 cases took vaginal delivery; they were divided into a good outcome group (80 cases) and an adverse outcome group (52 bases) according to their pregnancy outcomes. One hundred and thirty-two healthy pregnant women who gave birth during the same period were selected as a control group; they were (28.65±3.06) years old; their BMI was (25.31±2.67) kg/m²; their gestation weeks was (38.21±1.33); among them, there were 60 multiparae; 86 women took vaginal delivery. The general clinical data were collected and analyzed for univariate analysis. Multivariate logistic regression was applied to analyze the influencing factors of adverse pregnancy outcomes in the women with GDM. The receiver operating characteristic curve (ROC) was applied to analyze the diagnostic values of IRS-1 and CTRP3 for adverse pregnancy outcomes in the patients with GDM. Pearson method and Spearman correlation analysis were applied to analyze the correlations of IRS-1 and CTRP3 with the clinical indicators and pregnancy outcomes in the women with GDM. χ² test, t test, and Pearson and Spearman correlation analyses were used. Results　The serum levels of IRS-1 and CTRP3 in the diseased group were obviously lower than those in the control group [(1.82±0.21) μg/L vs. (2.33±0.28) μg/L and (353.51±38.14) ng/L vs. (425.95±45.21) ng/L], with statistical differences (t=16.74 and 14.07; both P<0.05). The serum levels of IRS-1 and CTRP3 in the adverse outcome group were lower than those in the good outcome group; the levels of fasting blood glucose (FBG), glycated hemoglobin (HbAlc), and insulin resistance index (HOMA-IR) in the adverse outcome group were higher than those in the good outcome group; there were statistical differences (t=8.61, 7.49, 7.26, 8.40, and 32.73; all P<0.05). The elevated levels of FBG, HbAlc, and HOMA-IR were all risk factors for adverse pregnancy outcomes in the patients [OR (95%CI)=1.498 (1.099-2.042), 1.698 (1.092-2.639), and 2.014 (1.063-3.816); all P<0.05], while IRS-1 and CTRP3 were protective factors for adverse pregnancy outcomes in the patients [OR (95%CI)=0.774 (0.621-0.964) and 0.731 (0.573-0.932); both P<0.05]. The ROC showed that the area under the curve (AUC) of the combination of IRS-1 and CTRP3 for adverse pregnancy outcomes in the patients was 0.899; the AUC of the combination was obviously better than those of IRS-1 and CTRP3 (Z=2.094 and 2.056; both P<0.05). IRS-1 and CTRP3 were negatively correlated with pregnancy outcomes, FBG, HbAlc, and HOMA-IR in the patients (all P<0.05). Conclusions　The serum levels of IRS-1 and CTRP3 decrease in GDM patients with adverse pregnancy outcomes. The combination of the two has certain predictive value for adverse pregnancy outcomes in patients with GDM.

Key words:

Gestational diabetes mellitus, regnancy outcomes, Insulin receptor substrate-1, C1q tumor necrosis factor related protein-3

摘要：

目的　分析血清胰岛素底物受体-1（IRS-1）、C1q肿瘤坏死因子相关蛋白-3（CTRP3）水平与妊娠糖尿病（GDM）患者不良妊娠结局的相关性。方法　采用前瞻性研究，选取2021年1月至2023年12月在陕西中医药大学第二附属医院分娩的132例GDM孕妇为患病组［年龄（28.76±3.18）岁，体重指数（BMI）为（25.72±2.82）kg/m²，孕周（38.06±1.42）周，经产孕妇66例，阴道分娩82例］，根据妊娠结局分为良好结局组（80例）与不良结局组（52例）；另选同期分娩的健康孕妇132名为对照组［年龄（28.65±3.06）岁，BMI（25.31±2.67）kg/m²，孕周（38.21±1.33）周，经产孕妇60例，阴道分娩86例］。对不同妊娠结局GDM患者临床资料进行单因素分析，多因素logistic回归分析孕妇不良妊娠结局的影响因素，绘制受试者操作特征曲线（ROC）分析IRS-1、CTRP3对GDM患者不良妊娠结局的诊断价值，分析IRS-1、CTRP3与临床指标及孕妇妊娠结局的相关性。统计学方法采用χ²检验、t检验、Pearson及Spearman相关性分析。结果　患病组血清IRS-1、CTRP3水平均低于对照组［（1.82±0.21）μg/L比（2.33±0.28）μg/L、（353.51±38.14）ng/L比（425.95±45.21）ng/L］，差异均有统计学意义（t=16.74、14.07，均P<0.05）；不良结局组血清IRS-1、CTRP3水平均低于良好结局组，空腹血糖（FBG）、糖化血红蛋白（HbAlc）、胰岛素抵抗指数（HOMA-IR）水平均高于良好结局组，差异均有统计学意义（t=8.61、7.49、7.26、8.40、32.73，均P<0.05）；FBG、HbAlc、HOMA-IR水平升高均为影响患者不良妊娠结局的危险因素［比值比（OR）=1.498，95%置信区间（CI） 1.099～2.042；OR=1.698，95%CI 1.092～2.639；OR=2.014，95%CI 1.063～3.816；均P<0.05］，IRS-1、CTRP3均为影响患者不良妊娠结局的保护因素［OR=0.774，95%CI 0.621～0.964；OR=0.731，95%CI 0.573～0.932；均P<0.05］；ROC显示，IRS-1、CTRP3联合诊断患者不良妊娠结局的曲线下面积（AUC）为0.899，联合诊断的AUC优于IRS-1、CTRP3单独诊断（Z=2.094、2.056，均P<0.05）；IRS-1、CTRP3与孕妇妊娠结局及FBG、HbAlc、HOMA-IR均呈负相关（均P<0.05）。结论　不良妊娠结局GDM患者血清IRS-1、CTRP3水平降低，二者联合对患者不良妊娠结局有一定预测价值。

关键词:

妊娠糖尿病, 妊娠结局, 胰岛素底物受体-1, C1q肿瘤坏死因子相关蛋白-3