基于Irisin、Kisspeptin、SHBG构建妊娠期糖尿病早产的风险模型及其验证-东南大学学报医学版

基于Irisin、Kisspeptin、SHBG构建妊娠期糖尿病早产的风险模型及其验证

单位：绵阳市中心医院妇产科, 四川绵阳 621000

关键词：妊娠期糖尿病早产鸢尾素人吻素-1编码的肽类激素性激素结合球蛋白列线图模型

分类号：R587.1; R714.256; R195.1

出版年·卷·期（页码）：2023·42·第六期（813-819）

摘要：

目的:基于鸢尾素(Irisin)、人吻素-1编码的肽类激素Kisspeptin、性激素结合球蛋白(SHBG)构建妊娠期糖尿病(GDM)早产的风险模型,并验证模型的预测价值。方法:选取2017年2月至2022年1月237例GDM患者,根据是否发生早产分为发生组(n=78)、未发生组(n=159),比较两组一般资料、Irisin、Kisspeptin、SHBG,采用Logistic回归分析早产的相关影响因素,使用R语言绘制预测早产的列线图模型,并对模型进行内部与外部验证。结果:发生组空腹血糖、餐后2 h血糖高于未发生组(P＜0.05);发生组孕24周、孕28周、分娩前Irisin、SHBG低于未发生组,Kisspeptin高于未发生组(P＜0.05);空腹血糖、餐后2 h血糖、Irisin、Kisspeptin、SHBG均与早产相关(P＜0.05);基于Logistic回归分析绘制预测早产的列线图模型,该模型预测早产的C-index为0.972(95%CI:0.718~0.994),区分度为0.801,校准度为0.925,提示分类结果与实际结果具有较高的符合度。结论:Irisin、SHBG降低及Kisspeptin升高均与GDM患者早产风险增加相关,基于各指标构建的预测早产列线图模型能为临床早期预测妊娠结局提供可靠参考,从而指导临床及时管理、干预,促进结局的改善。

Objective: To construct a risk model for preterm delivery in gestational diabetes mellitus(GDM) based on Irisin, the human kissin-1 encoded peptide hormone Kisspeptin, and sex hormone-binding globulin(SHBG), and to validate the predictive value of the model. Methods: 237 patients with GDM from February 2017 to January 2022 were selected and divided into incident group(n=78) and non-incident group(n=159) according to whether preterm delivery occurred, comparing general information, Irisin, Kisspeptin and SHBG between the two groups, analyzing the influencing factors related to preterm delivery using Logistic regression, drawing a nomogram model for predicting preterm delivery using R language, and validating the model internally and externally. Results: Fasting glucose and 2 h postprandial glucose were higher in the incident group than those in the non-incident group(P<0.05); Irisin and SHBG at 24 weeks of gestation, 28 weeks of gestation and before delivery were lower in the incident group than those in the non-incident group, and Kisspeptin was higher than that in the non-incident group(P<0.05); fasting glucose, 2 h postprandial glucose, Irisin, Kisspeptin and SHBG were all associated with preterm delivery(P<0.05); based on Logistic regression analysis to plot the nomogram model for predicting preterm labor, the C-index of the model for predicting preterm delivery was 0.972(95%CI:0.718-0.994), with a discrimination of 0.801 and a calibration of 0.925, suggesting that the predicted classification results have a high degree of compliance with the actual results. Conclusion: The decreased Irisin, SHBG and increased Kisspeptin are all associated with increased risk of preterm delivery in patients with GDM, and the nomogram model of predicting preterm delivery constructed based on each index can provide a reliable reference for clinical early prediction of pregnancy outcome, thus guiding clinical timely management, intervention and promoting improvement of outcome.

参考文献：

[1] CHRISTOS C,PAOLO C,ALEXANDROS S.Gestational diabetes mellitus pharmacological prevention and treatment[J].Curr Pharm Des,2021,27(36):3833-3840.
[2] WU Y T,ZHANG C J,MOL B W,et al.Early prediction of gestational diabetes mellitus in the Chinese population via advanced machine learning[J].J Clin Endocrinol Metab,2021,106(3):e1191-e1205.
[3] AL-GHAZALI M J,ALI H A,AL-RUFAIE M M.Serum irisin levels as a potential marker for diagnosis of gestational diabetes mellitus[J].Acta Biomed,2020,91(1):56-63.
[4] KAPUSTIN R V,DROBINTSEVA A O,ALEKSEENKOVA E N,et al.Placental protein expression of kisspeptin-1(KISS1) and the kisspeptin-1 receptor(KISS1R) in pregnancy complicated by diabetes mellitus or preeclampsia[J].Arch Gynecol Obstet,2020,301(2):437-445.
[5] SIDDIQUI K,GEORGE T P,JOY S S,et al.Association of sex hormone binding globulin with gestational age and parity in gestational diabetes mellitus[J].J Matern Fetal Neonatal Med,2022,35(8):1433-1438.
[6] 中华医学会妇产科学分会产科学组,中华医学会围产医学分会妊娠合并糖尿病协作组.妊娠合并糖尿病诊治指南(2014)[J].中华妇产科杂志,2014,49(8):561-569.
[7] TANG N,CHEN Y,WU W,et al.Association between plasma irisin in pregnancy and postpartum glucose levels among Chinese women:a cohort study[J].J Diabetes Investig,2021,12(9):1723-1731.
[8] ERSAHIN S S,YURCI A.Cord blood and maternal serum preptin and irisin concentrations are regulated independently in GDM[J].Eur Rev Med Pharmacol Sci,2021,25(4):1954-1958.
[9] 杨春丽,杨敬敬,洪腾.胰岛素结合格列本脲治疗妊娠期糖尿病对患者妊娠结局及Nesfatin-1、Irisin水平影响[J].中国计划生育学杂志,2022,30(1):46-49.
[10] ONAT T,INANDIKLIOGLU N.Circulating Myonectin and Irisin levels in gestational diabetes mellitus - a case-control study[J].Z Geburtshilfe Neonatol,2021,225(4):320-326.
[11] MILLS E G,IZZI-ENGBEAYA C,ABBARA A,et al.Functions of galanin,spexin and kisspeptin in metabolism,mood and behaviour[J].Nat Rev Endocrinol,2021,17(2):97-113.
[12] HUANG C,WANG H Y,WANG M E,et al.Kisspeptin-activated autophagy independently suppresses non-glucose-stimulated insulin secretion from pancreatic β-cells[J].Sci Rep,2019,9(1):17451.
[13] 赵晔,张艳明,胡月玲,等.黄芪四君子汤联合二甲双胍治疗妊娠期糖尿病临床观察[J].山东医药,2021,61(4):61-64.
[14] MUSA E,MATJILA M,LEVITT N S.Kisspeptins and glucose homeostasis in pregnancy:implications for gestational diabetes mellitus-a review article[J].Reprod Sci,2022,29(2):321-327.
[15] LEE E B,DILOWER I,MARSH C A,et al.Sexual dimorphism in Kisspeptin signaling[J].Cells,2022,11(7):1146.
[16] LUO X,CAI W Y,SONG J Y,et al.Predictive value of circulating sex hormone-binding globulin for gestational diabetes:a meta-analysis[J].Biomark Med,2021,15(12):1043-1053.
[17] WANDER P L,CHRISTOPHI C A,ARANETA M R G,et al.Adiposity,related biomarkers,and type 2 diabetes after gestational diabetes:the Diabetes Prevention Program[J].Obesity(Silver Spring),2022,30(1):221-228.
[18] LIU W,HUANG Z,TANG S,et al.Changes of serum sex hormone-binding globulin,homocysteine,and hypersensitive CRP levels during pregnancy and their relationship with gestational diabetes mellitus[J].Gynecol Obstet Invest,2021,86(1-2):193-199.
[19] LI M Y,RAWAL S,HINKLE S N,et al.Sex hormone-binding globulin,cardiometabolic biomarkers,and gestational diabetes:a longitudinal study and meta-analysis[J].Matern Fetal Med,2020,2(1):2-9.
[20] SAHOO D,PATTANAIK S R,KUMAR P R,et al.Role of serum Irisin during early pregnancy to predict the development of gestational diabetes mellitus at 24-28 weeks of pregnancy in high-risk patients[J].Indian J Endocrinol Metab,2022,26(1):61-67.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录