Page 77 - 中国全科医学2022-18

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As serum complement C1q/tumor necrosis factor-related protein 3 （CTRP3） ratio is closely related to insulin resistance，
which may be involved in the development of GDM. However，the association and predictive value of serum CTRP3 ratio with
GDM in early pregnancy have been rarely reported. Objective To explore the association and predictive value of serum CTRP3
ratio with GDM in early pregnancy，providing new ideas for the prevention and treatment of GDM. Methods Women in early
pregnancy who underwent regular obstetric examinations in Obstetric Clinic，Affiliated Hospital of Chengde Medical University，
were prospectively and consecutively enrolled from June 2018 to March 2019. Demographics，fasting plasma glucose（FPG），
fasting insulin （FINS），glycosylated hemoglobin（HbA 1c ），triglyceride （TG），total cholesterol （TC），high-density
lipoprotein cholesterol （HDL-C），low-density lipoprotein cholesterol （LDL-C） and serum CTRP3 ratio measured at 6-14
weeks of gestation were collected. The 75 g oral glucose tolerance test（OGTT） was performed to screen GDM at 24-28 weeks
of gestation. The patients were divided into GDM group and normal glucose tolerance（NGT）group. Results Finally，368 of
the 393 cases were enrolled for analysis，including 81（22.0%） who were detected with GDM by the 75 g OGTT. Compared
with those with normal glucose tolerance（NGT） diagnosed by the 75 g OGTT，GDM cases had much greater average age，
pre-pregnancy BMI，FPG，FINS，HbA 1c ，and TG（P<0.05）. Serum CTRP3 ratio in GDM group was lower than that in
NGT group〔0.528 0 （0.461 3，0.634 0） μg/L vs 0.604 8 （0.510 8，0.666 0） μg/L，P=0.001〕. Multivariate Logistic
regression analysis showed that serum CTRP3 ratio was an independently associated with GDM〔aOR=0.101，95%CI（0.010，
0.997），P ≤ 0.05〕. The AUC of serum CTRP3 ratio in predicting GDM was 0.622〔95%CI（0.571，0.672）〕with 49.38%
sensitivity，and 72.13% specificity when ≤ 0.524 2 μg/L was chosen as the optimal cutoff value. The AUC of a combined
prediction model（serum CTRP3 ratio in combination with age，pre-pregnancy BMI，FPG and HbA 1c ） in predicting GDM was
0.841〔95%CI（0.799，0.877）〕，with 69.14% sensitivity and 89.20% specificity when 0.315 0 was chosen as the optimal
cutoff value. The AUC of the combined prediction model was greater than that of serum CTRP3 ratio（Z=5.634，P<0.001）.
Conclusion Increased serum CTRP3 ratio may be associated with lowered risk of GDM，so it could be used as an independent
predictor for GDM in early pregnancy. Furthermore，its combined use with maternal demographic and metabolic indicators may
produce a better predictive value for GDM in early pregnancy.
【Key words】 Diabetes，gestational；CTRP3；Body mass index；Glucose tolerance test

妊娠期糖尿病（gestational diabetes mellitus，GDM） CTRP3 水平低于糖耐量正常（normal glucose tolerance，
以胰岛 β 细胞功能受损和胰岛素抵抗为特征，是妊 NGT）组，CTRP3 与胰岛 β 细胞功能呈正相关，与胰
娠期间首次被识别的任何程度的葡萄糖不耐受 ［1］ 。 岛素抵抗呈负相关 ［16］ ，提示血清 CTRP3 可能参与了
随着生育年龄推迟、不合理饮食习惯及肥胖的流行， GDM 的发生、发展过程。但妊娠早期血清 CTRP3 是
GDM 发病率呈逐年上升趋势 ［2］ ，我国 GDM 发病率为 否影响 GDM 的发生及其对 GDM 的预测价值如何，尚
13.0%~20.9% ［3-6］ 。随着母体血糖的升高，孕产妇、胎 未完全明确。本研究主要探讨妊娠早期血清 CTRP3 对
儿及新生儿不良结局的发生风险均增加 ［7］ 。分娩后部 GDM 的影响及预测价值，为 GDM 防治提供新思路。
分 GDM 患者血糖水平可以恢复正常，17%~63% 的妇 1 资料与方法
女在分娩后 5~16 年发展为 2 型糖尿病，子代在成年早 1.1 临床资料 前瞻性连续选取 2018 年 6 月至 2019
期发生代谢综合征的风险也升高 ［8-9］ 。对 GDM 患者进 年 3 月在承德医学院附属医院产科门诊正规产检的妊娠
行筛查、诊断和治疗可改善不良妊娠结局及新生儿短期 早期女性为研究对象。研究对象均签署知情同意书。本
预后 ［10］ ，但不能改善对新生儿长期不良结局的影响， 研究已通过承德医学院附属医院医学伦理委员会的批准
且 GDM 筛查时机尚存争议 ［11］ 。因此，在妊娠早期对 （批准文号 LL027）。
GDM 进行预测并及时进行有效干预尤为重要。 1.2 纳入标准 承德市常住居民，年龄 18~45 岁，自
妊娠期糖代谢的紊乱是 GDM 发生的基础，但发 然受孕，单胎，孕周 6~14 周，计划在承德医学院附属
生机制尚不完全清楚。肥胖与胰岛素抵抗、糖尿病的 医院分娩。
发生密切相关，而补体 C1q/ 肿瘤坏死因子相关蛋白 3 1.3 排除标准 患有 1 型或 2 型糖尿病、慢性高血压，
（complement-C1q/tumor necrosis factor-related proteins， 妊娠前有经药物治疗的血脂异常、心血管疾病等，活动
CTRP3）作为脂肪因子超家族中的一员，参与了肥胖、 性或慢性肝、肾或其他器官疾病，近 3 个月内有急性或
胰岛素抵抗等多种内分泌过程 ［12-15］ ，推测脂肪细胞 慢性感染史，有吸烟史、饮酒史，近期服用影响糖代谢
因子引起的代谢紊乱可能与 GDM 的发生有关。一项 的药物。
关于妊娠 24~28 周女性的研究发现，GDM 组孕妇血清 1.4 研究方法