血清1- 硬脂酰-sn- 甘油-3- 磷酰胆碱水平检测对妊娠期糖尿病的诊断价值

目的 探讨血清1- 硬脂酰-sn- 甘油-3- 磷酰胆碱(1-stearoyl-sn-glycero-3-phosphorylcholine, LPC18:0)水平检测对妊娠期糖尿病(gestational diabetes mellitus, GDM)的诊断价值。方法 选择2020 年5 ～ 12 月在枣庄市妇幼保健院进行产前检查的孕妇60 例为研究对象，根据口服葡萄糖耐量试验(oral glucose tolerance test，OGTT) 测定结果将妊娠妇女分为GDM 孕妇(观察组)30 例和糖耐量正常孕妇(对照组)30 例。利用液相色谱- 串联质谱(liquidchromatography-tandem mass spectrometry, LC-MS/MS)的代谢组学技术检测两组孕妇血清 LPC18:0 表达水平，分析GDM 孕妇血清LPC18:0 水平与临床、糖脂指标的相关性，利用受试者工作特征曲线(receiver operating characteristiccurve，ROC)评价血清中LPC18:0 诊断GDM 的价值。结果 观察组LPC 18:0100.42(76.80，142.08)μg/ml]、总胆固醇(TC)(3.52 ± 0.51 mmol/L )、空腹血糖(FPG)(5.31 ± 2.12 mmol/L )、低密度脂蛋白- 胆固醇(LDL-C)(3.81± 0.98 mmol/L)、空腹胰岛素(FINS)(16.65 ± 6.78μIU/ml)、胰岛素抵抗指数(HOMA-IR)(3.32 ± 1.08)和糖化血红蛋白(HbA1c)(5.61 %± 0.31 %)水平均高于对照组［30.88(22.08，40.60) μg/ml，3.12 ± 0.68 mmol/L，5.01 ± 1.47 mmol/L，3.42 ± 0.52 mmol/L， 10.98 ± 4.89 μIU/ml，2.27 ± 0.99 ，5.01 %± 0.50 %］，差异有统计学意义(z=-5.28，t=2.48 2.83，3.01，3.43，4.43，5.34，均P ＜ 0.05)。观察组和对照组孕妇三酰甘油(TG)(2.11 ± 0.47mmol/L vs 1.91 ± 0.82 mmol/L)，高密度脂蛋白- 胆固醇(HDL-C)(1.98 ± 0.38 mmol/L vs 2.01 ± 0.56 mmol/L)水平比较，差异均无统计学意义(t=0.66，-0.67，均P ＞ 0. 05)。GDM 孕妇血清LPC18:0 水平与孕妇年龄、孕前体重指数，TG，HDL-C，HbA1c 水平无相关性(r=-0.14 ~ 0.17，均P ＞ 0.05)，与FPG，TC，LDL-C 水平呈正相关(r=0.28，0.41，0.46，均P ＜ 0.05)，与FINS，HOMA-IR 呈负相关(r= -0.33，-0.51，均P ＜ 0.05)。ROC 曲线分析结果显示，区别诊断GDM孕妇及正常孕妇时，血清LPC18:0 的曲线下面积(area under curve，AUC)为 0.988(95%CI: 0.964 ～ 1.000)，当最佳临界值62.25 μg/ml 时，特异度和灵敏度分别为95% 和90%。结论 利用LC-MS/MS 方法检测GDM 孕妇血清LPC18:0 水平较正常孕妇明显升高，血清LPC18:0 水平检测对GDM 有一定的诊断价值。

Diagnostic Value of Serum 1-Stearoyl-sn-Glycero-3-Phosphorylcholine Level in Gestational Diabetes Mellitus

Objective To investigate the diagnostic value of serum 1-stearoyl-sn-glycero-3-phosphorylcholine (LPC18:0) level in gestational diabetes mellitus (GDM). Methods A total of 60 pregnant women who underwent prenatal examination in Maternal and Child Health Hospital of Zaozhuang from May to December 2020 were selected as the study subjects. According to oral glucose tolerance test(OGTT) measurement results, pregnant women were divided into GDM pregnant women (observation group) 30 cases, normal glucose tolerance pregnant women(control group) 30 cases. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to detect the expression of LPC18:0 in serum of two groups of pregnant women. The correlation between serum LPC18:0 level and clinical and glucolipid indexes in pregnant women with GDM was analyzed, and the diagnostic value of serum LPC18:0 in GDM was evaluated by receiver operating characteristic curve (ROC). Results LPC18:0100.42 (76.80, 142.08)μg/ml], total cholesterol (TC) (3.52 ± 0.51 mmol/L), fasting glucose (FPG) (5.31 ± 2.12 mmol/L), low density lipoprotein -cholesterol(LDL-C) (3.81 ± 0.98 mmol/L), fasting insulin (FINS) (16.65 ± 6.78 μIU/ ml), the levels of insulin resistance index (HOMA-IR) (3.32 ± 1.08 ) and HbA1c (5.61%±0.31%) were higher than those of the control group30.88(22.08，40.60) μg/ml，3.12 ± 0.68 mmol/L，5.01 ± 1.47 mmol/L，3.42 ± 0.52 mmol/L， 10.98 ± 4.89 μIU/ml，2.27 ± 0.99 ，5.01 %± 0.50 %]，the differences were statistical significant (z=-5.28，t=2.48，2.83，3.01，3.43， 4.43，5.34，all P<0.05). Comparison of triglyceride (TG)(2.11 ± 0.47 mmol/L vs 1.91 ± 0.82 mmol/L)and high-density lipoprotein-cholesterol (HDL-C) (1.98 ± 0.38 mmol/L vs 2.01 ± 0.56 mmol/L) levels between observation group and control group, there differences were no statistically significant(t=0.66, -0.67, all P ＞ 0.05). Spearman correlation analysis showed that there was no correlation between serum LPC18.0 level and pregnant women’s age, prepregnancy body mass index, TG, HDL-C and HbA1c (r=-0.14 ~ 0.17，all P>0.05)，and positively correlated with FPG, TC and LDL-C (r=0.28，0.41，0.46，all P＜ 0.05), and negatively correlated with FINS and HOMA-IR (r=-0.33,-0.51, all P ＜ 0.05). ROC curve analysis showed that the area under curve (AUC) of serum LPC18.0 in GDM pregnant women was 0.988(95%CI: 0.964 ～ 1.000). When the optimal critical value was 62.25 μg/ml，the specificity and sensitivity were 95% and 90%, respectively. Conclusion The level of serum LPC18:0 in pregnant women with GDM detected by LC-MS/MS was significantly higher than that in normal pregnant women, and the detection of serum LPC18:0 has certain diagnostic value for GDM.