Relationships of serum Xenin-25 and activin A expression levels with pregnancy outcome in patients with gestational diabetes mellitus
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摘要:目的
探讨妊娠期糖尿病(GDM)患者血清赛宁-25(Xenin-25)、激活素A(activin A)表达水平与妊娠结局的关系。
方法选取2020年12月—2023年2月本院收治的269例GDM孕妇为研究对象，检测血清Xenin-25、activin A水平，记录妊娠结局。根据妊娠结局的不同将GDM患者分为妊娠结局不良组(91例)和妊娠结局良好组(178例)。分析GDM患者不良妊娠结局的影响因素以及Xenin-25、activin A预测GDM妊娠结局的价值。
结果妊娠结局不良组年龄、孕前体质量指数(BMI)、不良孕产史占比以及空腹血糖(FPG)、糖化血红蛋白(HbA1c)、activin A水平高于妊娠结局良好组，血清Xenin-25水平低于妊娠结局良好组，差异有统计学意义(P < 0.05)。高HbA1c与高activin A水平是GDM患者妊娠结局的危险因素(P < 0.05), 高Xenin-25是妊娠结局的保护因素(P < 0.05)。Xenin-25、activin A预测GDM患者不良妊娠结局的曲线下面积分别为0.895、0.865, 二者联合预测的曲线下面积为0.981, 高于Xenin-25或activin A单独预测(P < 0.05)。
结论GDM患者血清Xenin-25、activin A与不良妊娠结局有关，可作为妊娠结局预测的标志物。
Abstract:ObjectiveTo investigate the relationships of serum levels of Xenin-25 and activin A with pregnancy outcomes in patients with gestational diabetes mellitus (GDM).
MethodsA total of 269 pregnant women with GDM admitted to our hospital between December 2020 and February 2023 were enrolled. Serum levels of Xenin-25 and activin A were measured, and pregnancy outcomes were recorded. Based on pregnancy outcomes, patients were divided into poor pregnancy outcome group (91 cases) and good pregnancy outcome group (178 cases). The influencing factors of adverse pregnancy outcomes of GDM patients and the predictive value of Xenin-25 and activin A for GDM pregnancy outcomes were analyzed.
ResultsThe poor pregnancy outcome group had higher age, pre-pregnancy body mass index (BMI), proportion of adverse obstetric history, as well as levels of fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), and activin A compared to the good pregnancy outcome group, and serum level of Xenin-25 was lower in the poor pregnancy outcome group (P < 0.05). High HbA1c and high activin A levels were identified as risk factors for pregnancy outcomes in GDM patients, while high Xenin-25 was a protective factor for pregnancy outcomes (P < 0.05). The areas under the curve (AUCs) for predicting adverse pregnancy outcomes in GDM patients using Xenin-25 and activin A were 0.895 and 0.865, respectively, while the AUC for combined prediction was 0.981, which was higher than that of Xenin-25 or activin A alone(P < 0.05).
ConclusionXenin-25 and activin A in GDM patients are associated with adverse pregnancy outcomes and can serve as biomarkers for predicting pregnancy outcomes.
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表 1 不同妊娠结局GDM患者基线资料比较(x±s)[n(%)]
基线资料 分类 妊娠结局不良组(n=91) 妊娠结局良好组(n=178) t/χ2 P 年龄/岁 34.15±3.06 32.96±2.18 3.677 ＜0.001 孕前BMI/(kg/m2) 24.12±2.02 22.86±2.13 4.670 ＜0.001 孕期体质量增加/kg 8.32±1.67 7.98±1.73 1.543 0.124 入组孕周/周 30.12±1.02 30.21±1.13 0.638 0.524 糖尿病家族史 有 21(23.08) 43(24.16) 0.039 0.844 无 70(76.92) 135(75.84) 不良孕产史 有 25(27.47) 26(14.61) 6.487 0.011 无 66(72.53) 152(85.39) 血压 收缩压/mmHg 121.02±8.46 120.38±7.95 0.611 0.542 舒张压/mmHg 73.25±6.34 72.98±6.27 0.333 0.740 糖脂代谢指标 TG/(mmol/L) 2.97±0.21 2.93±0.20 0.019 0.985 TC/(mmol/L) 4.92±0.63 4.89±0.58 0.390 0.697 FPG/(mmol/L) 8.21±1.35 7.21±1.06 6.656 ＜0.001 FINS/(pmol/mL) 13.62±2.49 13.47±2.38 0.481 0.631 HbA1c/% 7.91±1.06 6.35±1.24 10.238 ＜0.001 BMI: 体质量指数; TG: 甘油三酯; TC: 总胆固醇; FPG: 空腹血糖; FINS: 空腹胰岛素; HbA1c: 糖化血红蛋白。 
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表 2 不同妊娠结局的GDM患者血清Xenin-25、activin A表达水平比较(x±s)
组别 n Xenin-25/(pg/mL) activin A/(ng/mL) 妊娠结局不良组 91 86.15±20.43 56.32±12.41 妊娠结局良好组 178 138.46±38.19* 33.15±10.57* Xenin-25: 血清赛宁-25; activin A: 激活素A。
与妊娠结局不良组比较, * P＜0.05。
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表 3 GDM患者不良妊娠结局的多因素Logistic回归分析
变量 β SE Wald2 OR(95%CI) P 常量 14.352 4.092 12.301 — ＜0.001 HbA1c 1.352 0.465 8.453 3.865(1.553~9.616) ＜0.001 activin A 0.705 0.320 4.853 2.023(1.081~3.789) 0.020 Xenin-25 -0.685 0.275 6.204 0.504(0.294~0.864) ＜0.001 HbA1c: 糖化血红蛋白; activin A: 激活素A; Xenin-25: 血清赛宁-25。
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表 4 Xenin-25、activin A预测GDM患者不良妊娠结局的价值
指标 曲线下面积(95%CI) 临界值 灵敏度/% 特异度/% 约登指数 Xenin-25 0.895(0.852~0.929) 108.46 pg/mL 83.52 84.83 0.684 activin A 0.865(0.818~0.903) 46.81 ng/mL 85.71 87.60 0.733 联合预测 0.981(0.957~0.994) — 96.70 83.71 0.804
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