Association between TyG,FGF-21 and lipid glucose metabolism and the early prediction value for gestational diabetes mellitus
Objective To investigate the association between triglyceride-glucose product index(TyG),fibroblast growth factor 21(FGF-21)and lipid glucose metabolism and the early prediction value for gestational diabetes mellitus(GDM).Methods A total of 678 pregnant women who received prenatal examination and hospitalized delivery in Fourth People's Hospital of Langfang city from June 2018 to November 2022 were selected.All pregnant women were followed up to 24-28 weeks of pregnancy,and finally 622 pregnant women were included in the study.Among 622 pregnant women,85(13.67％)were diagnosed with GDM and included in the GDM group;the remaining 537 pregnant women with normal glucose tolerance(NGT)were included in the NGT group.Pre-pregnancy body mass index(BMI)and general clinical data at 11 to 15 weeks of gestation were collected,the serum levels of TyG and FGF-21 were compared in early pregnancy.The correlation between TyG and FGF-21 and lipid glucose metabolism indexes in GDM patients was analyzed.Multiple linear stepwise regression model was used to analyze the factors affecting the occurrence of GDM.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of TyG and FGF-21 to GDM.Results Compared with NGT group,pre-pregnancy BMI,triglyceride(TG),low density lipid-cholesterol(LDL-C),fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c),fasting insulin(FINS),homeostasis model assessment for insulin resistance(HOMA-IR),TyG index,FGF-21 increased significantly in GDM group(t/Z=4.938,3.668,7.710,12.698,11.962,5.103,12.671,4.063,9.716),and homeostasis model assessment for the estimate of β-cell secretion(HOMA-β)decreased significantly in GDM group(t=10.079),all the differences were statistically significant(all P＜0.05).TyG index was positively correlated with TG,LDL-C,FPG,FINS and HOMA-IR(r=0.568,0.530,0.567,0.581,0.609),and negatively correlated with HOMA-β(r=-0.613),all the differences were statistically significant(all P＜0.05).FGF-21 was positively correlated with LDL-C,FPG,FINS and HOMA-IR(r=0.519,0.466,0.455,0.536)and negatively correlated with HOMA-β(r=-0.583),all the differences were statistically significant(all P＜0.05).TG,FPG,FINS,HOMA-IR,HOMA-β,TyG index and FGF-21 were independent influencing factors of GDM after adjusting for other confounding factors(all P＜0.05).The area under the curve(AUC)of GDM predicted by TyG index was 0.791,the AUC of FGF-21 was 0.738,and the AUC of GDM combined by the two was 0.829.The AUC of GDM predicted by the combination of the two indexes was higher than that predicted by TyG index and FGF-21 alone(Z=3.026,3.197;all P＜0.05).Conclusion TyG index and FGF-21 in early pregnancy were independent predictors of the onset of GDM,and their combination could further improve the predictive value.
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