血清CRTC3、FABP4和apo CⅢ水平对妊娠期糖尿病患者不良妊娠结局的预测价值

摘要/Abstract

摘要： 目的：观察血清环磷酸腺苷反应元件结合蛋白调节转录辅激活因子3（CRTC3）、脂肪酸结合蛋白4（FABP4）和载脂蛋白CⅢ（apo CⅢ）水平对妊娠期糖尿病（GDM）患者妊娠结局的预测价值。方法：选择2021年1月至2022年6月在我院诊治的GDM患者118例，为GDM组。选择同期在我院就诊的正常妊娠孕妇75例，为对照组。比较两组孕妇血清CRTC3、apo CⅢ和FABP4水平的差异；探讨GDM组患者血清CRTC3、apo CⅢ和FABP4水平与血糖控制程度的关系；开展GDM患者不良妊娠结局影响因素的单因素和多因素分析，探讨发生不良妊娠结局的独立危险因素；探讨血清CRTC3、apo CⅢ和FABP4水平在预测GDM患者妊娠结局的诊断效能。结果：GDM组患者血清CRTC3、apo CⅢ和FABP4水平均高于对照组（P<0.01），并随着GDM控制程度提升而降低。妊娠结局不良组GDM患者年龄、孕前BMI水平、不良孕产史、血糖控制情况、TG、CRTC3、apo CⅢ和FABP4水平与妊娠结局良好组相比，差异均有统计学意义（P<0.01），而两组患者产次、血清TC、HDL-C和LDL-C水平差异均无统计学意义（P>0.05）。多因素分析结果发现血清CRTC3、apo CⅢ和FABP4水平升高是GDM患者发生不良妊娠结局的独立危险因素（P<0.05）。血清CRTC3、apo CⅢ和FABP4水平在预测GDM患者发生不良妊娠结局具有较高的诊断效能，联合检测的灵敏度为92.6%，特异度为89.0%，AUC为0.956，均高于单个指标CRTC3（z=2.559，P=0.010）、apo CⅢ（z=3.212，P=0.001）和FABP4（z=2.687，P=0.007），而3个指标之间的AUC比较差异无统计学意义（P>0.05）。结论：血清CRTC3、apo CⅢ和FABP4水平参与了GDM的发生发展，是GDM患者发生不良妊娠结局的独立危险因素，联合检测有助于提高对不良妊娠结局的诊断效能。

关键词: font-size:medium, ">CREB调节转录辅激活因子3；脂肪酸结合蛋白4；载脂蛋白CⅢ；妊娠期糖尿病；妊娠结局不良

Abstract: Objective： To investigate the predictive value of CREB regulated transcription coactivator 3 (CRTC3)， fatty acid binding protein 4 (FABP4) and apo CⅢ for adverse pregnancy outcomes in patients with gestational diabetes mellitus (GDM). Methods： 118 patients with GDM treated in our hospital from January 2021 to June 2022 were selected as the GDM group. 75 normal pregnant women treated in our hospital during the same period were selected as the control group. The serum levels of CRTC3， apo CⅢ and FABP4 were compared between the two groups. The relationship between serum CRTC3， apo CⅢ and FABP4 levels and the degree of blood glucose control was discussed. The univariate and multivariate analysis of the influencing factors of adverse pregnancy outcomes in GDM patients were analyzed. The diagnostic efficacy of serum CRTC3， apo CⅢ and FABP4 levels in predicting adverse pregnancy outcomes in GDM patients was performed. Results： The serum levels of CRTC3， apo CⅢ and FABP4 in GDM group were higher than those in the control group (P<0.01)， and decreased with the increase of GDM control degree. There was significant difference in the age， pre-pregnancy BMI， adverse pregnancy history， poor blood glucose control， TG， CRTC3， apo CⅢ and FABP4 levels of patients in the poor pregnancy outcome group and the good pregnancy outcome group (P<0.01). There were no significant differences in the parity， serum TC， HDL-C and LDL-C levels between the two groups of patients(P>0.05). Multivariate analysis showed that increased serum levels of CRTC3， apo CⅢ and FABP4 were independent risk factors for adverse pregnancy outcomes (P<0.05). Serum CRTC3， apo CⅢ and FABP4 levels had high diagnostic efficacy in the prediction of adverse pregnancy outcomes in GDM patients. The sensitivity and specificity of combined detection respectively were 92.6%， 89.0% and AUC was 0.956， which were significantly higher than that of CRTC3 (z=2.559， P=0.010)， apo CⅢ (z=3.212， P=0.001) and FABP4 (z=2.687， P=0.007)， while there was no significant difference in AUC among the three indexes (P>0.05). Conclusion： Serum CRTC3， apo CⅢ and FABP4 levels are involved in the occurrence and development of GDM， and are independent risk factors for adverse pregnancy outcomes in GDM patients. Combined detection is helpful to improve the diagnostic efficacy for adverse pregnancy outcomes.

Key words: font-size:medium, ">CREB regulated transcription coactivator 3；Fatty acid binding protein 4； Apolipoprotein CⅢ； Gestational diabetes mellitus； Poor pregnancy outcome

中图分类号:

王芸. 血清CRTC3、FABP4和apo CⅢ水平对妊娠期糖尿病患者不良妊娠结局的预测价值[J]. 中国医药导刊, 2023, 25(7): 744-749.

WANG Yun. Predictive Value of Serum CRTC3， FABP4 and apo CⅢ Levels for Adverse Pregnancy Outcomes in Patients with Gestational Diabetes Mellitus[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2023, 25(7): 744-749.

参考文献

[1]Gao C， Sun X， Lu L， et al. Prevalence of gestational diabetes mellitus in mainland China：a systematic review and meta-analysis[J]. J Diabetes Investig， 2019， 10(1)：154-162.
     [2]Furukawa S， Miyakawa K， Shibata J， et al. Women with subclinical hypothyroidism are at low risk of poor pregnancy outcome in Japan[J]. Tohoku J Exp Med， 2017， 242(3)：167-172.
     [3]Liu J， Xu Z， Wu W， et al. Regulation role of CRTC3 in skeletal muscle and adipose tissue[J]. J Cell Physiol， 2018， 233(2)：818-821.
     [4]Iimura Y， Matsuura M， Yao Z， et al. Lack of predictive power of plasma lipids or lipoproteins for gestational diabetes mellitus in Japanese women[J]. J Diabetes Investig， 2015， 6(6)：640-646.
     [5]Ruszala M， Niebrzydowska M， Pilszyk A， et al. Novel biomolecules in the pathogenesis of gestational diabetes mellitus[J]. Int J Mol Sci， 2021， 22(21)：125-136.
     [6]李樉,王晨,杨慧霞.《国际妇产科联盟妊娠期糖尿病实用指南》摘译(二):妊娠合并糖尿病的诊断[J].中华围产医学杂志, 2016, 19(5):363, 376.
     [7]Sesmilo G， Prats P， lvarez M， et al. Gestational diabetes prevalence and outcomes in women undergoing assisted reproductive techniques (ART)[J]. Endocrinología Diabetes Nutr， 2022， 69(10)：75-80.
     [8]武强,刘梦,柯文才,等. 2型糖尿病及腹型肥胖患者血清CRTC3水平与胰岛素抵抗的相关性研究[J]. 中华内分泌代谢杂志, 2019, 35(9):761-764.
     [9]Yoo H， Lee HR， Kim KH， et al. CRTC3， a sensor and key regulator for melanogenesis， as a tunable therapeutic target for pigmentary disorders[J]. Theranostics， 2021， 11(20)：9918-9936.
     [10]Sonntag T， Ostojic J， Vaughan JM， et al. Mitogenic signals stimulate the CREB coactivator CRTC3 through PP2A recruitment[J]. iScience， 2019， 11：134-145.
     [11]Liu J， You W， Xu Z， et al. Rapid communication：porcine CRTC3 gene clone， expression pattern， and its regulatory role in intestinal epithelial cells[J]. J Anim Sci， 2018， 96(7)：2622-2628.
     [12]刘秀娟，许洪梅. 妊娠期糖尿病孕妇血清CRTC3水平及与糖脂代谢和妊娠结局的关系[J]. 中国妇幼保健， 2022， 37(6)：1002-1004.
     [13]Hieronimus B， Stanhope KL. Dietary fructose and dyslipidemia： new mechanisms involving apolipoprotein CⅢ[J]. Curr Opin Lipidol， 2020， 31(1)：20-26.
     [14]de la Parra SL， Gutierrez-Uribe JA， Sharma A， et al. Is Apo-CⅢ the new cardiovascular target? An analysis of its current clinical and dietetic therapies[J]. Nutr Metab Cardiovasc Dis， 2022， 32(2)：295-308.
     [15]Reyes-Soffer G, Sztalryd C, Horenstein RB, et al. Effects of APOC3 heterozygous deficiency on plasma lipid and lipoprotein metabolism[J]. Arteriosclerosis Thrombosis and Vascular Biology, 2019, 39(1):63-72.
     [16]Lappas M， Georgiou HM， Velagic A， et al. Do postpartum levels of apolipoproteins prospectively predict the development of type 2 diabetes in women with previous gestational diabetes mellitus?[J]. Exp Clin Endocrinol Diabetes， 2019， 127(6)：353-358.
     [17]Duan B， Li Y， Dong K， et al. Regulative effect of maternal serum fatty acid-binding protein 4 on insulin resistance and the development of gestational diabetes mellitus[J]. Prostaglandins Leukot Essent Fatty Acids， 2020， 163：102213.
     [18]Jin C， Lin L， Han N， et al. Risk of gestational diabetes mellitus in relation to plasma concentrations of fatty acid-binding protein 4： a nested case-control study in China[J]. J Diabetes Res， 2021， 2021：6681432.
     [19]唐正和，刘翠明，马学芹，等. 妊娠期糖尿病患者血清Metrnl、FABP4水平变化及临床意义[J]. 中国计划生育和妇产科， 2023， 15(1)：73-76.
     [20]Ning H， Tao H， Weng Z， et al. Correction to： serum fatty acid-binding protein 4 (FABP4) as a novel biomarker to predict gestational diabetes mellitus[J]. Acta Diabetol， 2018， 55(10)：1089.

快速检索引用检索图表检索高级检索