孕早、中期唐氏筛查血清标志物与妊娠期糖尿病的相关性研究

目的 探讨孕早、中期唐氏筛查血清标志物与妊娠期糖尿病（gestational diabetes mellitus,GDM）的相关性。方法 回顾性分析GDM孕妇（GDM组）202例和正常孕妇（对照组）337例的临床资料,比较2组早孕期血清中人绒毛膜促性腺激素（human chorionic gonadotropin,β-HCG）、妊娠相关蛋白A（pregnancy-associated plasma protein-A,PAPP-A）和中孕期血清中甲胎蛋白（alpha-fetal protein,AFP）、β-HCG、游离雌三醇（unconjugated estriol,uE3）水平。Logistic多因素分析确定发生GDM的影响因素,采用受试者工作特征曲线分析血清标志物对GDM的预测价值。结果 GDM组孕妇孕早期体重指数（body mass index,BMI）大于对照组,孕早期PAPP-A中位数倍数（multiple of median,MoM）值低于对照组（P＜0.01）。Logistic多因素回归分析结果显示,孕早期BMI≥24、孕早期PAPP-A MoM值<0.8、孕中期β-HCG MoM值≥1.5是孕妇发生GDM的影响因素。ROC曲线分析结果显示,孕妇孕早期BMI和PAPP-A MoM值预测GDM发生的ROC面积分别为0.664和0.687。结论 孕早期BMI、孕早期血清PAPP-A水平是发生GDM的影响因素。

Study on the relationship between Down's screening serum markers and gestational diabetes mellitus

Objective To explore the relationship between Down's screening serum markers and gestational diabetes mellitus(GDM). Methods The clinical data of 202 pregnant women(GDM group) and 337 normal pregnant women (control group) with GDM were analyzed retrospectively. The serum levels of human chorionic gonadotropin(β-HCG), pregnancy-associated plasma protein-A(PAPP-A) and alpha-fetal protein(AFP), β-HCG, unconjugated estriol(uE3) in 2 groups were compared. Logistic multivariate analysis was used to determine the influencing factors of GDM, and the working characteristic curve of subjects was used to analyze the predictive value of serum markers to GDM. Results The body mass index (BMI) in GDM group was higher than that in the control group, and the multiple of median(MoM) of PAPP-A in GDM group was lower than that in the control group(P＜0.01). Logistic regression analysis showed that BMI≥ 24, PAPP-A MoM<0.8 and β-HCG MoM≥1.5 in the first trimester were the influencing factors of GDM. ROC curve analysis showed that BMI and PAPP-A MoM predicted the areas of ROC in GDM were 0.664 and 0.687 respectively. Conclusion BMI in early pregnancy and the level of PAPP-A in serum are the influencing factors of GDM.