目的 探讨孕中期胱抑素C(cystatin C,Cys-C)联合血清铁蛋白(serum ferritin,SF)检测对妊娠期糖尿病(gestational diabetes mellitus,GDM)患者妊娠不良结局的预测价值.方法 回顾性分析2015-03/2023-03月收治的159例GDM患者临床资料,根据患者最终妊娠结局分为妊娠结局不良组(n=31)和妊娠结局良好组(n=128).收集两组GDM患者年龄、产次、孕前体质量指数(body mass index,BMI)、孕中期BMI、不良孕产史、糖尿病家族史、高血压史、高脂血症史,并检测GDM患者孕中期血清Cys-C、SF及糖化血红蛋白(glycosylated hemoglobin A1c,HbA1 c)水平;Logistic回归模型分析GDM患者发生妊娠不良结局的危险因素;采用受试者工作特征(receiver operating characteristic,ROC)曲线评估Cys-C、SF及二者联合检测对GDM患者妊娠不良结局的预测价值.结果 与妊娠结局良好组相比,妊娠结局不良组GDM患者年龄、产次、孕前BMI、不良孕产史、糖尿病家族史、高血压史、高脂血症史差异无统计学意义(P＞0.05),而孕中期Cys-C、SF、HbA1c水平及孕中期BMI明显升高(P均＜0.05).Logistic回归分析结果显示,HbA1 C、Cys-C、SF表达水平升高是GDM患者妊娠不良结局风险增加的危险因素.ROC曲线分析结果显示,孕中期Cys-C及SF预测GDM患者妊娠不良结局曲线下面积(area under the curve,AUC)分别为0.743、0.783,灵敏度分别为86.59％、86.67％,特异度分别为63.89％、66.67％,而二者联合检测预测GDM患者妊娠不良结局AUC为0.798,灵敏度86.67％,特异度72.22％,优于单一检测的Cys-C或SF.结论 孕中期Cys-C联合SF检测评估GDM患者的妊娠结局具有良好的预测价值.
Predictive Value of Cystatin C Combined with Ferritin Detection in Mid-pregnancy for Adverse Pregnancy Outcomes in Pa-tients with Gestational Diabetes Mellitus
Objective To explore the predictive value of cystatin C(Cys-C)combined with serum ferritin(SF)de-tection in mid-pregnancy for adverse pregnancy outcomes in patients with gestational diabetes mellitus(GDM).Methods The clinicl data of 159 GDM patients in author's hospital from March 2015 to March 2023 were retrospectively analyzed,and they were divided into adverse pregnancy outcome group(n=31)and good pregnancy outcome group(n=128)according to the final pregnancy outcomes of the patients.The age,parity,pre-pregnancy body mass index(BMI),mid-pregnancy BMI,adverse pregnancy and childbirth history,family history of diabetes mellitus,history of hypertension and history of hyperlipidemia of the GDM patients were collected,and the mid-pregnancy serum Cys-C,SF and glycosy-lated hemoglobin A1 c(HbA1 c)level of the GDM patients were detected;the risk factors of adverse pregnancy outcomes in GDM patients were analyzed by Logistic regression model;the predictive value of Cys-C,SF and combined detection of the two for adverse pregnancy outcomes in patients with GDM were evaluated by the receiver operating characteristic(ROC)curve.Results Compared with the good pregnancy outcome group,there were no statistical differences in age,parity,mid-pregnancy BMI,adverse pregnancy and childbirth history,family history of diabetes mellitus,history of hy-pertension and history of hyperlipidemia in the adverse pregnancy outcome group(P＞0.05),while the levels of mid-pregnancy Cys-C,SF,HbA1c and mid-pregnancy BMI significantly increased(all P＜0.05).Logistic regression analysis results showed that the increased expression levels of HbA1 c,Cys-C and SF were risk factors for the increased risk of ad-verse pregnancy outcomes in GDM patients.The results of the ROC curve showed that the area under the curve(AUC)of mid-pregnancy Cys-C and SF predicting adverse pregnancy outcomes in GDM patients were 0.743 and 0.783 respectively,the sensitivities were 86.59％and 86.67％re-spectively and the specificities were 63.89％and 66.67％re-spectively,and the AUC of the combination of the two was 0.798,the sensitivity was 86.67％and the specificity was 72.22％,which was better than single test of Cys-C or SF.Conclusion Cys-C combined with SF detection in mid-pregnancy has a good predictive value in assessing pregnancy out-comes in patients with GDM.
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