血清ANGPTL4、GRP78水平与妊娠期糖尿病病人不良妊娠结局的相关性

张新; 危丽华

血清ANGPTL4、GRP78水平与妊娠期糖尿病病人不良妊娠结局的相关性

张新,
危丽华

Correlation between serum ANGPTL4, GRP78 levels and poor pregnancy outcomes in patients with gestational diabetes mellitus

摘要

摘要:
目的： 检测血清血管生成素样蛋白4(ANGPTL4) 、葡萄糖调节蛋白78(GRP78)水平，并探讨两者与妊娠糖尿病（GDM）病人不良妊娠结局的关系。
方法： 以300例GDM病人作为GDM组，选取同期孕检的300名健康孕妇作为对照组。酶联免疫吸附（ELISA）法检测血清ANGPTL4、GRP78水平，根据GDM病人妊娠结局情况分为妊娠结局良好组（174例）和妊娠结局不良组（126例）；Spearman相关性分析血清ANGPTL4、GRP78水平与不良妊娠结局的相关性；多因素logistic回归分析GDM不良妊娠结局的影响因素；ROC曲线评估血清ANGPTL4、GRP78对GDM不良妊娠结局的预测价值。
结果： GDM组血清ANGPTL4水平低于对照组（P ＜ 0.01），GDM组GRP78水平明显高于对照组（P ＜ 0.01）。妊娠结局良好组年龄、孕周、FBG、HOMA-IR、血清GRP78水平显著低于妊娠结局不良组（P ＜ 0.05～P ＜ 0.01），妊娠结局良好组分娩前BMI、血清ANGPTL4水平显著高于妊娠结局不良组（P ＜ 0.01）。Spearman相关性分析结果显示，GDM病人血清ANGPTL4水平与孕妇不良妊娠结局呈负相关（P ＜ 0.01），GRP78水平与孕妇不良妊娠结局呈正相关（P ＜ 0.01）。logistic回归分析显示，血清ANGPTL4、GRP78、年龄、孕周、分娩前BMI、FBG、HOMA-IR均是GDM病人发生不良妊娠结局的危险因素（P ＜ 0.05～P ＜ 0.01）。ROC曲线结果显示，血清ANGPTL4、GRP78联合预测GDM病人不良妊娠结局的AUC显著大于ANGPTL4单独预测的AUC（P ＜ 0.05）及GRP78单独预测的AUC（P ＜ 0.01）。
结论： GDM病人血清ANGPTL4水平明显降低，GRP78水平明显升高，对评估GDM妊娠结局有一定参考意义。

Abstract:
Objective To detect the levels of serum angiopoietin-like protein 4 (ANGPTL4) and glucose regulated protein 78 (GRP78), and to explore the relationship between them and poor pregnancy outcomes in patients with gestational diabetes mellitus (GDM).
Methods Three hundred GDM patients were used as the GDM group, and 300 healthy pregnant women from the same pregnancy test period were collected as the control group. Enzyme linked immunosorbent assay (ELISA) was applied to detect serum levels of ANGPTL4 and GRP78. According to the pregnancy outcomes of GDM patients, they were grouped into a good pregnancy outcomes group (174 cases) and a poor pregnancy outcomes group (126 cases). Spearman correlation was applied to analyze the correlation between serum levels of ANGPTL4 and GRP78 and poor pregnancy outcomes. Multivariate logistic regression was applied to analyze the influencing factors of poor pregnancy outcomes in GDM. ROC curve was applied to evaluate the predictive value of serum ANGPTL4 and GRP78 for poor pregnancy outcomes in GDM.
Results The serum ANGPTL4 level in the GDM group was obviously lower than that in the control group (P ＜ 0.01), and the GRP78 level in the GDM group was obviously higher than that in the control group (P ＜ 0.01). The age, gestational week, FBG, HOMA-IR, and serum GRP78 level in the good pregnancy outcomes group were obviously lower than those in the poor pregnancy outcomes group (P ＜ 0.05 to P ＜ 0.01), the pre-delivery BMI and serum ANGPTL4 level in the good pregnancy outcomes group were obviously higher than those in the poor pregnancy outcomes group (P ＜ 0.01). The Spearman correlation analysis showed that the serum level of ANGPTL4 in GDM patients was negatively correlated with poor pregnancy outcomes in pregnant women (P ＜ 0.01), while the level of GRP78 was positively correlated with poor pregnancy outcomes in pregnant women (P ＜ 0.01). Logistic regression analysis showed that serum ANGPTL4, GRP78, age, gestational week, pre-delivery BMI, FBG, and HOMA-IR were all risk factors for poor pregnancy outcomes in GDM patients (P ＜ 0.05 to P ＜ 0.01). The ROC curve results showed that the AUC predicted by the combination of serum ANGPTL4 and GRP78 for poor pregnancy outcomes in GDM patients was obviously higher than that predicted by ANGPTL4 alone (P ＜ 0.05) and GRP78 alone (P ＜ 0.01).
Conclusion The serum ANGPTL4 levels were significantly lower and GRP78 levels were significantly higher in GDM patients, which has certain reference significance for evaluating the pregnancy outcomes of GDM.

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