孕早期血清脂肪因子CTRP6与妊娠糖尿病的关系

目的 研究孕早期妇女血清补体C1q/肿瘤坏死因子相关蛋白6（C1q/tumor necrosis factor-related protein 6，CTRP6）的表达水平，探讨其与妊娠糖尿病（gestational diabetes mellitus，GDM）的关系。方法 前瞻性连续选取2021年3月至2022年3月在郑州大学第二附属医院门诊产检的孕10~13周孕妇，收集孕妇的年龄、身高、体质量、末次月经时间，检测孕早期总胆固醇（total cholesterol，TC）、三酰甘油（triglyceride，TG）、高密度脂蛋白（high density lipoprotein，HDL）、低密度脂蛋白（low density lipoprotein，LDL）、空腹血糖（fasting plasma glucose，FPG）、糖化血红蛋白（glycosylated hemoglobin，HbA1c）、空腹胰岛素（fasting insulin，FINS）、CTRP6水平，计算孕前体质量指数（body mass index，BMI）、基线BMI、产前BMI和胰岛素抵抗指数（亦称胰岛素抵抗的稳态模型评估，homeostatic model assessment of insulin resistance，HOMA-IR）。所有孕妇均于孕24~28周行75g口服葡萄糖耐量试验，根据试验结果分为GDM组和糖耐量正常（normal glucose tolerance，NGT）组。比较两组孕妇孕早期的临床资料及实验室指标，分析孕早期血清CTRP6与各指标的相关性及其与GDM的关系。结果 共纳入孕妇213例，完整随访203例，其中52例孕妇被诊断为GDM，GDM发病率25.62%。GDM组孕妇的孕早期血清CTRP6、年龄、孕前BMI、基线BMI、产前BMI、TC、LDL、FPG、HbA1c、FINS、HOMA-IR均较NGT组升高，差异有统计学意义（P<0.05）。孕早期CTRP6与年龄、孕前BMI、基线BMI、产前BMI、TG、LDL、FPG、HbA1c、FINS、HOMA-IR 呈正相关，与HDL呈负相关（P<0.05）。校正年龄、BMI、糖脂代谢指标及HOMA-IR后，孕早期CTRP6为GDM发病的独立影响因素。结论 孕早期血清CTRP6升高与GDM相关，是GDM的独立危险因素。

Association of serum adipokine CTRP6 in early pregnancy with gestational diabetes mellitus

Objective To study the expression levels of serum complement C1q/tumor necrosis factor-related protein 6 (CTRP6) in women in early pregnancy and to explore its relationship with gestational diabetes mellitus (GDM). Methods Women at the Second Affiliated Hospital of Zhengzhou University from March 2021 to March 2022 were prospectively and consecutively selected from 10 to 13 weeks gestation for outpatient obstetric check-ups. The age, height, weight, and time of last menstruation of pregnant women were collected, and the levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS) and CTRP6 were measured in early pregnancy, and the pre-pregnancy body mass index (BMI), baseline BMI, prenatal BMI, and homeostatic model assessment of insulin resistance (HOMA-IR) were calculated. All pregnant women underwent a 75g oral glucose tolerance test at 24-28 weeks of gestation and were divided into GDM group and normal glucose tolerance (NGT) group according to the test results. The clinical data and laboratory indexes of the two groups in early pregnancy were compared, and the correlation between serum CTRP6 and various indexes in early pregnancy and its relationship with GDM were analyzed. Results A total of 213 maternal cases were enrolled, and 203 cases were completed for follow-up. Among them, 52 mothers were diagnosed with GDM, with a GDM prevalence rate of 25.62%. Serum CTRP6, age, pre-pregnancy BMI, baseline BMI, antenatal BMI, TC, LDL, FPG, HbA1c, FINS, and HOMA-IR were higher in GDM group compared to NGT group, with a statistically significant difference (P<0.05). CTRP6 in early pregnancy was positively correlated with age, pre-pregnancy BMI, baseline BMI, prenatal BMI, TG, LDL, FPG, HbA1c, FINS, HOMA-IR, and negatively correlated with HDL (P<0.05). After correcting for age, BMI, glycolipid metabolism index and HOMA-IR, CTRP6 in early pregnancy remained an independent factor in the development of GDM. Conclusion Elevated serum CTRP6 in early pregnancy is associated with GDM and is an independent risk factor for GDM.