妊娠糖尿病患者血清microRNA-873-5p、ZEB1与胰岛素抵抗、母婴结局的相关性研究

Correlation of serum microRNA-873-5p and ZEB1 levels with insulin resistance, maternal, and infant outcomes in patients with gestational diabetes mellitus

摘要:

目的 探究妊娠糖尿病（GDM）患者血清microRNA-873-5p（miR-873-5p）、E盒结合锌指蛋白1（ZEB1）与胰岛素抵抗、母婴结局的相关性。方法 选取连云港市第一人民医院2021年1月—2022年6月收治的137例GDM患者为研究组，另选取同期该院体检且一般资料与研究组患者相匹配的137例健康孕妇为对照组。实时荧光定量聚合酶链反应（qRT-PCR）检测两组研究对象血清miR-873-5p、ZEB1的表达；Pearson法分析GDM患者血清miR-873-5p、ZEB1与胰岛素抵抗指数（HOMA-IR）的相关性；多因素一般Logistic回归分析影响GDM患者母婴结局的相关因素；绘制受试者工作特征（ROC）曲线分析miR-873-5p、ZEB1对GDM患者母婴不良结局的预测效能。结果 研究组患者的空腹血糖（FPG）、空腹胰岛素（FINS）及HOMA-IR均高于对照组（P <0.05）；研究组患者血清miR-873-5p、ZEB1水平均高于对照组（P <0.05）；Pearson法分析结果显示，GDM患者血清miR-873-5p表达（r =0.754，P =0.000）、ZEB1表达（r =0.771，P =0.000）与HOMA-IR均呈正相关；母婴不良结局组的GDM患者血清miR-873-5p、ZEB1表达均高于良好结局组（P <0.05）；FPG［O^R=1.366（95% CI：1.065，1.752）］、FINS［O^R=1.619（95% CI：1.214，2.160）］、HOMA-IR［O^R=1.550（95% CI：1.146，2.096）］、miR-873-5p［O^R=1.772（95% CI：1.250，2.512）］及ZEB1［O^R=1.512（95% CI：1.050，2.177）］均为GDM患者发生母婴不良结局的危险因素（P <0.05）；血清miR-873-5p、ZEB1及两者联合预测GDM患者发生母婴不良结局的敏感性分别为71.11%（95% CI：0.670，0.821）、66.67%（95% CI：0.620，0.715）和65.89%（95% CI：0.617，0.727），特异性分别为70.65%（95% CI：0.670，0.821）、85.87%（95% CI：0.775，0.897）和88.04%（95% CI：0.785，0.910），两者联合检测对GDM患者的母婴结局具有较高的特异性。结论 GDM患者血清miR-873-5p、ZEB1表达与胰岛素抵抗密切相关，并且两者联合检测对GDM患者的母婴结局具有较好的预测效能。

Abstract:

Objective To explore the relationship of serum microRNA-873-5p (miR-873-5p), zinc finger E-box-binding protein 1 (ZEB1) levels with insulin resistance, maternal, and infant outcomes in patients with gestational diabetes mellitus (GDM).Methods A total of 137 GDM patients admitted in our hospital from January 2021 to June 2022 were selected as the study group, and 137 healthy pregnant women who had physical examination in our hospital at the same time and whose general information matched the patients in the study group were selected as the control group. The expression levels of miR-873-5p and ZEB1 in serum of subjects in the two groups were detected, and Pearson method was applied to analyze the correlation of serum miR-873-5p and ZEB1 levels with insulin resistance index (HOMA-IR) in GDM patients; Logistic regression analysis was applied to analyze the related factors affecting the maternal and infant outcomes of GDM patients; the predictive efficacy of miR-873-5p and ZEB1 levels for adverse maternal and infant outcomes of GDM patients was analyzed by ROC curve.Results Fasting plasma glucose (FPG), fasting insulin (FINS), and HOMA-IR in the study group were obviously higher than those in the control group (P < 0.05); the levels of serum miR-873-5p and ZEB1 in the study group were higher than those in the control group (P < 0.05); Pearson analysis showed that the serum miR-873-5p level (r = 0.754, P = 0.000) and ZEB1 expression level (r = 0.771, P = 0.000) of GDM patients were positively correlated with HOMA-IR (P < 0.05); the expression levels of serum miR-873-5p and ZEB1 in GDM patients with adverse maternal and infant outcomes were obviously higher than those in the good outcomes group (P < 0.05); FPG level [O^R = 1.366 (95% CI: 1.065, 1.752) ], FINS level [O^R = 1.619 (95% CI: 1.214, 2.160) ], HOMA-IR level [O^R = 1.550 (95% CI: 1.146, 2.096) ], miR-873-5p level [O^R = 1.772 (95% CI: 1.250, 2.512) ]and ZEB1 level [O^R = 1.512 (95% CI: 1.050, 2.177) ] were risk factors for adverse maternal and infant outcomes in GDM patients (P < 0.05); The sensitivity of serum miR-873-5p, ZEB1, and their combination to predict the adverse maternal and infant outcomes in GDM patients was 71.11% (95% CI: 0.670, 0.821), 66.67% (95% CI: 0.620, 0.715), and 65.89% (95% CI: 0.617, 0.727), respectively; and the specificity was 70.65% (95% CI: 0.670, 0.821), 85.87% (95% CI: 0.775, 0.897) and 88.04% (95% CI: 0.785, 0.910), respectively. The combined detection of the two had higher specificity for the maternal and infant outcomes in GDM patients.Conclusion The expression levels of miR-873-5p and ZEB1 in serum of GDM patients are closely related to insulin resistance, and the combined detection of miR-873-5p and ZEB1 has a good predictive effect on the maternal and infant outcomes of GDM patients.