妊娠糖尿病孕妇子宫螺旋动脉血流参数、血清激活素A及内皮细胞特异性分子1对妊娠结局的影响

Impact of uterine spiral artery blood flow parameters, serum activin A, and endothelial cell-specific molecule 1 on pregnancy outcomes in women with gestational diabetes mellitus

摘要:

目的 探讨妊娠糖尿病（GDM）孕妇子宫螺旋动脉血流参数、血清激活素A及内皮细胞特异性分子1（Endocan）的表达特征，并分析其对妊娠结局的预测价值。方法 选取2024年5月—2025年5月青岛大学附属青岛妇女儿童医院收治的306例GDM孕妇作为研究组，根据妊娠结局分为妊娠正常组（208例）和妊娠不良组（98例），另选取50例同期健康孕妇作为对照组。采用超声检测子宫螺旋动脉血流参数，酶联免疫吸附试验检测血清激活素A、Endocan水平。采用多因素一般Logistic回归模型分析妊娠不良结局的危险因素，绘制受试者工作特征（ROC）曲线评估各指标对妊娠结局的预测效能。结果 妊娠不良组孕妇的空腹血糖（FPG）、糖化血红蛋白（HbA1c）、低密度脂蛋白胆固醇（LDL-C）水平均高于妊娠正常组（P <0.05）。妊娠不良组孕妇的搏动指数（PI）、阻力指数（RI）、收缩期峰值流速与舒张末期流速比值（S/D）水平均高于妊娠正常组（P <0.05），收缩期峰值流速（PSV）低于妊娠正常组（P <0.05）。妊娠不良组孕妇的血清激活素A、Endocan水平均高于妊娠正常组（P <0.05）。PI高水平［O^R =115.898（95% CI：9.558，1 405.364）］、RI高水平［O^R =187.342（95% CI：1.093，32 109.040）］、S/D高水平［O^R =4.024（95% CI：1.581，10.242）］、PSV低水平［O^R =0.504（95% CI：0.346，0.733）］、血清激活素A高水平［O^R =1.024（95% CI：1.015，1.033）］和Endocan高水平［O^R =1.029（95% CI：1.009，1.049）］均为GDM妊娠不良的危险因素（P <0.05）。子宫螺旋动脉血流参数、血清激活素A、Endocan水平联合预测GDM妊娠不良的曲线下面积为0.988（95% CI：0.975，1.000），敏感性为98.0%（95% CI：0.928，0.998），特异性为94.7%（95% CI：0.907，0.973）。结论 GDM孕妇子宫螺旋动脉血流参数异常、血清激活素A、Endocan水平升高与不良妊娠结局有关，联合检测可为预测GDM妊娠不良提供客观依据。

Abstract:

Objective To investigate the uterine spiral artery blood flow parameters, and the expression characteristics of serum activin A and endothelial cell-specific molecule 1 (Endocan) in women with gestational diabetes mellitus (GDM), and analyze their predictive value for pregnancy outcomes.Methods A total of 306 pregnant women with GDM admitted to Qingdao Women and Children's Hospital Affiliated to Qingdao University from May 2024 to May 2025 were selected as the study group, and divided into a normal pregnancy outcome group (208 cases) and an adverse pregnancy outcome group (98 cases) according to pregnancy outcomes. Another 50 healthy pregnant women during the same period were selected as the control group. Uterine spiral artery blood flow parameters were measured by ultrasound, and serum activin A and Endocan levels were detected by enzyme-linked immunosorbent assay (ELISA). General multivariate Logistic regression model was used to analyze the risk factors for adverse pregnancy outcomes, and receiver operating characteristic (ROC) curves were drawn to evaluate the predictive efficacy of each indicator for pregnancy outcomes.Results Fasting blood glucose (FPG), glycated hemoglobin (HbA1c), and low-density lipoprotein cholesterol (LDL-C) levels were significantly higher in the adverse outcome group than in the normal outcome group (P < 0.05). Pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio (S/D) were elevated in the adverse outcome group (P < 0.05), while peak systolic velocity (PSV) was reduced (P < 0.05). Serum activin A and Endocan levels were also significantly higher in the adverse outcome group (P < 0.05). Multivariate analysis indicated that high PI [O^R = 115.898 (95% CI: 9.558, 1 405.364) ], high RI [O^R = 187.342 (95% CI: 1.093, 32 109.040) ], elevated S/D [O^R = 4.024 (95% CI: 1.581, 10.242) ], low PSV [O^R = 0.504 (95% CI: 0.346, 0.733) ], high serum activin A [O^R = 1.024 (95% CI: 1.015, 1.033) ], and high Endocan [O^R = 1.029 (95% CI: 1.009, 1.049) ] were risk factors for adverse pregnancy outcomes in GDM (P < 0.05). The combined detection of uterine spiral artery blood flow parameters, serum activin A, and Endocan for predicting adverse pregnancy outcomes in GDM had an area under the curve (AUC) of 0.988 (95% CI: 0.975, 1.000), a sensitivity of 98.0% (95% CI: 0.928, 0.998), and a specificity of 94.7% (95% CI: 0.907, 0.973).Conclusion Abnormal uterine spiral artery blood flow parameters and elevated serum levels of activin A and Endocan in GDM pregnant women are associated with adverse pregnancy outcomes. Combined detection can provide an objective basis for predicting adverse pregnancy outcomes in GDM.