妊娠糖尿病患者血清C肽对妊娠不良事件和胎儿生长发育的预测价值

Predictive value of serum C-peptide in patients with gestational diabetes mellitus on adverse pregnancy events and fetal growth and development

摘要:

目的 探讨妊娠糖尿病（GDM）患者血清C肽对妊娠不良事件和胎儿生长发育的预测价值。方法 回顾性分析2021年6月—2022年12月在宣城市人民医院分娩的98例GDM患者的临床资料，统计GDM患者临床妊娠结局和胎儿生长发育情况。根据GDM患者妊娠结局分为结局不良组和结局良好组；根据胎儿生长发育情况分为发育异常组和发育正常组。比较结局不良组、结局良好组，发育异常组、发育正常组的临床资料及血清C肽水平。采用多因素Logistic逐步回归模型分析影响GDM患者妊娠结局和胎儿生长发育的相关因素。绘制受试者工作特征（ROC）曲线分析血清C肽对GDM患者妊娠不良事件和胎儿生长发育的预测效能。结果 98例GDM患者临床妊娠结局不良共37例、妊娠结局良好61例，胎儿发育异常22例、发育正常76例。结局不良组的年龄、孕次、空腹血糖（FPG）、糖化血红蛋白（HbA1c）及C肽水平高于结局良好组（P <0.05）。发育异常组FPG、HbA1c及C肽水平高于发育正常组（P <0.05）。多因素Logistic逐步回归分析结果显示：年龄 ［O^R =2.927（95% CI：1.056，8.111）］、HbA1c ［O^R =2.790（95% CI：1.007，7.731）］、C肽 ［O^R =3.086（95% CI：1.114，8.553）］均是影响GDM患者胎儿发育不良的危险因素（P <0.05）；HbA1c ［O^R =2.892（95% CI：1.044，8.014）］、C肽 ［O^R =3.267（95% CI：1.179，9.056）］均是影响GDM患者胎儿生长发育的独立因素（P <0.05）。ROC曲线分析结果显示：血清C肽预测GDM患者妊娠不良事件的临界值为423.25 pmol/L，敏感性为81.08%（95% CI：0.643，0.914），特异性为75.41%（95% CI：0.624，0.852），曲线下面积为0.741（95% CI：0.620，0.947）；血清C肽预测GDM患者胎儿生长发育的临界值为411.63 pmol/L，敏感性、特异性及曲线下面积分别为77.27%（95% CI：0.542，0.913）、71.05%（95% CI：0.594，0.806）、0.722（95% CI：0.623，0.808）。结论 血清C肽对GDM患者妊娠不良事件和胎儿生长发育的预测效能较高，可作为临床评估该类患者妊娠结局及其胎儿生长发育状况的重要参考指标。

Abstract:

Objective To investigate the predictive value of serum C-peptide in pregnant women with diabetes mellitus (GDM) for adverse pregnancy events and fetal growth and development.Methods The clinical data of 98 GDM patients who delivered in our hospital from December 2020 to December 2022 were retrospectively analyzed, and the clinical pregnancy outcome and fetal growth of GDM patients were statistically analyzed. According to the pregnancy outcome of GDM patients, they were divided into poor outcome group and good outcome group. According to the growth and development of the fetus, they were divided into two groups: abnormal development group and normal development group. The clinical data and serum C-peptide level of the poor outcome group and the good outcome group were compared. The clinical data and serum C-peptide level of dysplasia group and normal development group were compared. Multivariate regression analysis of factors related to pregnancy outcome and fetal growth and development in GDM patients. The ROC was made and the area under the curve (AUC) was used to analyze the predictive efficacy of serum C-peptide level on adverse pregnancy events and fetal growth and development in GDM patients.Results Among 98 GDM patients, 37 had bad pregnancy outcomes, 61 had good pregnancy outcomes, 22 had abnormal fetal development, and 76 had normal fetal development. Age, pregnancy times, FPG, HbA1c, and C-peptide levels in the poor outcome group were higher than those in the good outcome group (P < 0.05). Fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), and C-peptide levels in the dysplastic group were higher than those in the normal group (P < 0.05). Multivariate analysis showed that age [O^R = 2.927 (95% CI: 1.056, 8.111) ], HbA1c [O^R = 2.790 (95% CI: 1.007, 7.731) ], and C-peptide [O^R = 3.086 (95% CI: 1.114, 8.553) ] were risk factors for fetal dysplasia in GDM patients (P < 0.05). The levels of HbA1c [O^R = 2.892 (95% CI: 1.044, 8.014) ] and C-peptide [O^R = 3.267 (95% CI: 1.179, 9.056) ] were independent factors affecting the fetal growth and development of GDM patients (P < 0.05). ROC curve analysis showed that the critical value, sensitivity, specificity, and AUC of serum C-peptide for predicting adverse pregnancy events in GDM patients were 423.25 pmol/L, 81.08% (95% CI: 0.643, 0.914), 75.41% (95% CI: 0.624, 0.852), and 0.741 (95% CI: 0.620, 0.947), respectively. The critical value, sensitivity, specificity, and AUC of serum C-peptide in predicting fetal growth and development in GDM patients were 411.63 pmol/L, 77.27% (95% CI: 0.542, 0.913), 71.05% (95% CI: 0.594, 0.806) and 0.722 (95% CI: 0.623, 0.808), respectively.Conclusion The serum C-peptide level has a high predictive effect on adverse pregnancy events and fetal growth and development in GDM patients, and can be used as an important reference index for clinical evaluation of pregnancy outcome and fetal growth and development in such patients.