分泌型卷曲相关蛋白5与妊娠期糖尿病患者产后糖代谢异常的关系研究

目的 分析分泌型卷曲相关蛋白5（SFRP5）与妊娠期糖尿病（GDM）患者产后糖代谢异常的关系。方法 选取GDM患者238例，患者均于产后12周进行门诊复查，根据糖代谢情况分为糖代谢正常组和糖代谢异常组。收集所有患者的相关临床资料，采用酶联免疫吸附试验检测血清SFRP5水平。采用Logistic回归分析GDM患者产后糖代谢异常的危险因素。采用受试者工作特征（ROC）曲线分析相关指标对GDM患者产后糖代谢异常的预测价值。结果 238例GDM患者产后12周时糖代谢正常组192例，糖代谢异常组46例。糖代谢异常组的孕前体质量指数（BMI）、葡萄糖耐量试验（OGTT）1 h血糖均高于糖代谢正常组，血清SFRP5水平低于糖代谢正常组（P<0.05）。多因素Logistic回归分析显示，孕前BMI过高为GDM患者产后糖代谢异常的危险因素（OR=1.844，95%CI：1.099~3.094），而血清SFRP5水平升高则为GDM患者产后糖代谢异常的保护因素（OR=0.794，95%CI：0.645~0.977）。经ROC分析显示，孕前BMI及血清SFRP5预测GDM患者产后糖代谢异常的曲线下面积分别为0.727（95%CI：0.656~0.799）、0.715（95%CI：0.625~0.806），而两者联合使用后预测价值可得到进一步提升，ROC曲线下面积为0.809（95%CI：0.739~0.878）。结论 血清SFRP5水平与GDM患者产后糖代谢异常情况密切相关，其与孕前BMI联合应用对患者产后糖代谢异常有一定的预测价值。

The relationship between secreted frizzled-related protein 5 and abnormal postpartum glucose metabolism in patients with gestational diabetes mellitus

Objective To analyze the relationship between secreted frizzled-related protein 5 (SFRP5) and abnormal postpartum glucose metabolism in patients with gestational diabetes mellitus (GDM). Methods A total of 238 GDM patients were selected. All patients underwent outpatient reexamination at 12 weeks postpartum, and were divided into the normal glucose metabolism group and the abnormal glucose metabolism group according to their glucose metabolism. The relevant clinical data of all patients were collected, and the serum level of SFRP5 was detected by enzyme-linked immunosorbent assay. Logistic regression equation was used to analyze the risk factors of abnormal postpartum glucose metabolism in patients with GDM. Receiver operating characteristic curves (ROC) were used to analyze the predictive value of relevant indicators for postpartum glucose metabolism abnormalities in patients with GDM. Results Of the 238 GDM patients, 192 patients were in the normal glucose metabolism group and 46 patients were in the abnormal glucose metabolism group at 12 weeks postpartum. The pre-pregnancy body mass index (BMI) and the glucose tolerance test (OGTT) 1 h blood glucose were higher in the abnormal glucose metabolism group than those in the normal glucose metabolism group, and the serum SFRP5 level was lower than that in the normal glucose metabolism group (P<0.05). Multivariate Logistic regression analysis showed that high pre-pregnancy BMI (OR=1.844, 95%CI: 1.099-3.094) was a risk factor for postpartum abnormal glucose metabolism in GDM patients, while high serum SFRP5 level (OR=0.794, 95%CI: 0.645-0.977) was a protective factor for postpartum abnormal glucose metabolism in GDM patients (P<0.05). ROC analysis showed that the areas under the curve of progestational body mass index and serum SFRP5 in predicting postpartum glucose metabolism abnormalities in patients with GDM were 0.727 (95%CI: 0.656-0.799) and 0.715 (95%CI: 0.625-0.806), respectively. The predictive value could be further improved after the combination of the two, and the area under the curve of ROC was 0.809 (95%CI: 0.739-0.878). Conclusion Serum SFRP5 level is closely related to abnormal postpartum glucose metabolism in GDM patients, and its combined application with pre-pregnancy body mass index has certain predictive value for postpartum abnormal glucose metabolism.