血清IGF-1、IGFBP-3水平对妊娠期糖尿病初产妇不良妊娠结局的评估价值
| 作者: |
1张雪冰,
1李荣,
1何辉
1 池州市人民医院妇产科，安徽 池州 247000 |
| 通讯: |
张雪冰
Email: 875431776@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2023.221285 |
摘要
目的：探讨血清胰岛素样生长因子1(insulin-like growth factor-1，IGF-1)、胰岛素样生长因子结合蛋白3(insulin-like growth factor-binding protein-3，IGFBP-3)对妊娠期糖尿病(gestational diabetes mellitus，GDM)初产妇不良妊娠结局的评估价值。方法：选取GDM初产妇160例(GDM组)与健康孕产妇54例(对照组)，均于孕晚期检测血清IGF-1、IGFBP-3水平，对比2组IGF-1、IGFBP-3水平差异；分析IGF-1、IGFBP-3水平与GDM血糖控制状况(分为控制不良组与控制良好组)及妊娠结局(分为不良妊娠结局组与良好妊娠结局组)的关系，并应用受试者操作特征(receiver operating characteristic，ROC)曲线评价IGF-1、IGFBP-3及其联合对不良妊娠结局的预测效能。结果：相比对照组，GDM组孕晚期血清IGF-1水平显著降低(P<0.05)，IGFBP-3水平显著增高(P<0.05)。相比控制良好组，控制不良组IGF-1水平显著降低(P<0.05)，IGFBP-3水平显著增高(P<0.05)。相比良好妊娠结局组，不良妊娠结局组糖化血红蛋白(glycosylated hemoglobin，HbA1c)、IGFBP-3水平均显著增高(均P<0.05)，IGF-1水平显著降低(P<0.05)。Logistic回归分析显示：血清IGF-1、IGFBP-3是GDM初产妇出现不良妊娠结局的独立影响因素(均P<0.05)。ROC曲线分析显示：IGF-1预测GDM不良妊娠结局的曲线下面积(area under the curve，AUC)为0.732(95% CI：0.656~0.799)，IGFBP-3的AUC为0.648(95% CI：0.568~0.722)，二者差异无统计学意义(Z=1.251，P=0.165)；二者联合的AUC为0.771(95% CI：0.698~0.833)，优于单独使用IGF-1、IGFBP-3(Z=2.314、2.725，P=0.013、0.006)。结论：血清IGF-1、IGFBP-3与GDM初产妇不良妊娠结局有关，二者联合检测可提高对不良妊娠结局的预测价值。
关键词：
妊娠期糖尿病；妊娠结局；胰岛素样生长因子1；胰岛素样生长因子结合蛋白3
Evaluation value of serum IGF-1 and IGFBP-3 levels on adverse pregnancy outcomes in primipara with gestational diabetes mellitus
CorrespondingAuthor: ZHANG Xuebing Email: 875431776@qq.com
DOI: 10.3978/j.issn.2095-6959.2023.221285
Abstract
Objective: To investigate the predictive value of serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor-binding protein-3 (IGFBP-3) on adverse pregnancy outcomes of primipara with gestational diabetes mellitus (GDM).
Methods: A total of 160 primiparous women with GDM (GDM group) and 54 healthy pregnant women (control group) were selected. The serum levels of IGF-1 and IGFBP-3 were measured at late pregnancy and compared between the 2 groups. The relationship between the levels of IGF-1 and IGFBP-3, blood glucose control (divided into a group with good blood glucose control and a group with poor blood glucose control) and pregnancy outcomes (divided into a good pregnancy outcome group and a adverse pregnancy outcome group) in GDM was analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the predictive effect of IGF-1, IGFBP-3, and their combination on adverse pregnancy outcomes.
Results: Compared with the control group, the serum IGF-1 level in the GDM group at late pregnancy was significantly decreased (P<0.05), and the IGFBP-3 level was significantly increased (P<0.05). Compared with the group with good blood glucose control, the IGF-1 level in the group with poor blood glucose control was significantly decreased (P<0.05), and the IGFBP-3 level was significantly increased (P<0.05). Compared with the good pregnancy outcome group, the levels of glycosylated hemoglobin (HbA1c) and IGFBP-3 in the adverse pregnancy outcome group were significantly increased (both P<0.05) and the level of IGF-1 was significantly decreased (P<0.05). Logistic regression analysis showed that serum IGF-1 and IGFBP-3 were independent factors affecting adverse pregnancy outcomes in GDM primiparas (both P<0.05). ROC curve analysis showed that the area under the curve (AUC) of IGF-1 in predicting adverse pregnancy outcomes of GDM was 0.732 (95% CI 0.656 to 0.799), and the AUC of IGFBP-3 was 0.648 (95% CI 0.568 to 0.722). There was no significant difference between the 2 groups (Z=1.251, P=0.165). The AUC of the combination was 0.771 (95% CI 0.698 to 0.833), which was better than that of single IGF-1 or IGFBP-3 (Z=2.314, 2.725; P=0.013, 0.006).
Conclusion: Serum levels of IGF-1 and IGFBP-3 are associated with adverse pregnancy outcomes in GDM primipara, and the combined detection of them can improve the predictive value of adverse pregnancy outcomes.
Keywords：
gestational diabetes mellitus; pregnancy outcome; insulin-like growth factor-1; insulin-like growth factor-binding protein-3
Methods: A total of 160 primiparous women with GDM (GDM group) and 54 healthy pregnant women (control group) were selected. The serum levels of IGF-1 and IGFBP-3 were measured at late pregnancy and compared between the 2 groups. The relationship between the levels of IGF-1 and IGFBP-3, blood glucose control (divided into a group with good blood glucose control and a group with poor blood glucose control) and pregnancy outcomes (divided into a good pregnancy outcome group and a adverse pregnancy outcome group) in GDM was analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the predictive effect of IGF-1, IGFBP-3, and their combination on adverse pregnancy outcomes.
Results: Compared with the control group, the serum IGF-1 level in the GDM group at late pregnancy was significantly decreased (P<0.05), and the IGFBP-3 level was significantly increased (P<0.05). Compared with the group with good blood glucose control, the IGF-1 level in the group with poor blood glucose control was significantly decreased (P<0.05), and the IGFBP-3 level was significantly increased (P<0.05). Compared with the good pregnancy outcome group, the levels of glycosylated hemoglobin (HbA1c) and IGFBP-3 in the adverse pregnancy outcome group were significantly increased (both P<0.05) and the level of IGF-1 was significantly decreased (P<0.05). Logistic regression analysis showed that serum IGF-1 and IGFBP-3 were independent factors affecting adverse pregnancy outcomes in GDM primiparas (both P<0.05). ROC curve analysis showed that the area under the curve (AUC) of IGF-1 in predicting adverse pregnancy outcomes of GDM was 0.732 (95% CI 0.656 to 0.799), and the AUC of IGFBP-3 was 0.648 (95% CI 0.568 to 0.722). There was no significant difference between the 2 groups (Z=1.251, P=0.165). The AUC of the combination was 0.771 (95% CI 0.698 to 0.833), which was better than that of single IGF-1 or IGFBP-3 (Z=2.314, 2.725; P=0.013, 0.006).
Conclusion: Serum levels of IGF-1 and IGFBP-3 are associated with adverse pregnancy outcomes in GDM primipara, and the combined detection of them can improve the predictive value of adverse pregnancy outcomes.