■探讨孕早期妊娠相关血浆蛋白A(PAPP-A)的相关性及预测价值,母性因素,中国南方母亲妊娠期糖尿病(GDM)的生化指标。
■这项研究招募了4872名孕妇。PAPP-A,人绒毛膜促性腺激素的游离β亚基(游离β-HCG),空腹血糖(FPG),总胆固醇(TC),甘油三酯(TG),和高密度和低密度脂蛋白(高密度脂蛋白,LDL)在妊娠11-13周测量。在妊娠24-28周时,根据75g口服葡萄糖耐量试验诊断GDM。我们进行了逐步逻辑回归分析,以确定GDM的比值比(OR)和95%置信区间(CI)。我们使用受试者工作特征(ROC)曲线和曲线下面积(AUC)来评估PAPP-A的预测价值,母性因素,和生化标记。使用DeLong检验评估AUC值之间差异的显著性。
■在750名(15.39%)女性中诊断为GDM。GDM的独立因素是年龄,孕前BMI,GWG在诊断GDM之前,GDM的历史,糖尿病家族史,FPG,TG,LDL,PAPP-A,和TC。PAPP-A的AUC为0.56(95%CI0.53-0.58)。基于合并母体因素的模型的AUC,生化标志物,PAPP-A为0.70(95%CI0.68-0.72)。单独使用PAPP-A与基于合并母体因素的模型之间的AUC值差异,生化标志物,与PAPP-A比较,差异有统计学意义(Z=9.983,P<0.001)。
■孕早期血清PAPP-A水平低是妊娠后期发生GDM的独立危险因素。然而,尽管低血清PAPP-A水平与母体因素和生化标志物相结合时的预测价值增加,但这并不是一个很好的独立预测因子.
UNASSIGNED: To investigate the relationship and predictive value of first-trimester pregnancy-associated plasma protein A (PAPP-A), maternal factors, and biochemical parameters with gestational diabetes mellitus (GDM) in southern China mothers.
UNASSIGNED: This study recruited 4872 pregnant women. PAPP-A, the free beta subunit of human chorionic gonadotropin (free β-HCG), fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), and high- and low-density lipoproteins (HDL, LDL) were measured at 11-13+ weeks of gestation. GDM was diagnosed based on a 75 g oral glucose tolerance test at 24-28 weeks of gestation. We performed stepwise logistic regression analysis to determine the odds ratio (OR) and the 95% confidence interval (CI) of GDM. We used Receiver Operating Characteristic (ROC) curves with the area under the curve (AUC) to evaluate the predictive value of PAPP-A, maternal factors, and biochemical markers. The significance of the differences between the AUC values was assessed using the DeLong test.
UNASSIGNED: GDM was diagnosed in 750 (15.39%) women. Independent factors for GDM were age, pre-gestational BMI, GWG before a diagnosis of GDM, previous history of GDM, family history of diabetes, FPG, TG, LDL, PAPP-A, and TC. The AUC of PAPP-A was 0.56 (95% CI 0.53-0.58). The AUC of a model based on combined maternal factors, biochemical markers, and PAPP-A was 0.70 (95% CI 0.68-0.72). Differences in AUC values between PAPP-A alone and the model based on combined maternal factors, biochemical markers, and PAPP-A were statistically significant (Z= 9.983, P<0.001).
UNASSIGNED: A Low serum PAPP-A level in the first trimester is an independent risk factor for developing GDM later in pregnancy. However, it is not a good independent predictor although the predictive value of a low serum PAPP-A level increases when combined with maternal factors and biochemical markers.