基于倾向性评分匹配探讨妊娠早期空腹血清ANGPTL-2及ANGPTL-8水平预测妊娠期糖尿病的价值

doi:10.12280/gjfckx.20240680

摘要/Abstract

摘要：

目的：探讨孕妇妊娠早期血清血管生成素样蛋白2（angiopoietin-like protein-2，ANGPTL-2）及ANGPTL-8水平预测妊娠期糖尿病（gestational diabetes mellitus，GDM）的价值。方法：前瞻性收集2023年7—12月在临海市妇幼保健院产检的妊娠早期（10~13周）孕妇共135例，并采集静脉血，根据纳入排除标准最终纳入114例孕妇。根据妊娠24~28周口服葡萄糖耐量试验（oral glucose tolerance test，OGTT）结果，分为GDM组（15例）和对照组（99例）。按照孕妇年龄和产次，采用倾向性评分匹配（1∶1），共配对成功14对（即GDM组14例，对照组14例）。比较2组孕妇血清ANGPTL-2及ANGPTL-8蛋白水平，Pearson相关分析这2种蛋白水平与孕妇临床指标的相关性，受试者工作特征（receiver operating characteristic，ROC）曲线分析2种蛋白对GDM的预测价值。结果：GDM组孕妇血清ANGPTL-2及ANGPTL-8水平均高于对照组（均P<0.05）。Pearson相关分析表明，ANGPTL-2及ANGPTL-8与OGTT时空腹血糖水平呈正相关（r=0.537，P=0.003；r=0.394，P=0.038）。ROC曲线分析显示，ANGPTL-2和ANGPTL-8预测GDM发生的曲线下面积（area under the curve，AUC）分别为0.75（95%CI：0.57~0.93）、0.79（95%CI：0.61~0.97），二者联合预测的AUC为0.81（95%CI：0.65~0.97）。结论：妊娠早期血清ANGPTL-2和ANGPTL-8水平可作为GDM的早期预测指标，有助于促进GDM的早期识别和干预管理。

关键词: 血管生成素样蛋白质类, 血糖, 糖尿病, 妊娠, 预测, 早期诊断, 倾向性评分

Abstract:

Objective: To investigate the predictive value of serum angiopoietin-like protein-2 (ANGPTL-2) and ANGPTL-8 levels in early pregnancy for gestational diabetes mellitus (GDM) in pregnant women. Methods: A prospective study was conducted to collect data from 135 pregnant women in early pregnancy (10-13 weeks) who attended prenatal check-ups at Linhai Maternal and Child Health Hospital from July to December 2023. Venous blood was drawn, and based on inclusion and exclusion criteria, a total of 114 pregnant women were enrolled. According to the OGTT results at 24-28 weeks of gestation, participants were divided into the GDM group (15 cases) and the control group (99 cases). Propensity score matching (1∶1) was performed according to maternal age and parity, resulting in 14 successful matched pairs (14 cases in the GDM group and 14 cases in the control group). Serum levels of ANGPTL-2 and ANGPTL-8 were compared between the two groups, and Pearson correlation analysis was conducted to determine the correlation of these protein levels with clinical indicators in pregnant women. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of the two proteins for GDM. Results: Serum levels of ANGPTL-2 and ANGPTL-8 were significantly higher in the GDM group than in the control group (both P<0.05). Pearson correlation analysis indicated that both ANGPTL-2 and ANGPTL-8 were positively correlated with fasting blood glucose levels during the OGTT (r=0.537, P=0.003; r=0.394, P=0.038, respectively). ROC curve analysis revealed that the areas under the curve (AUC) for predicting GDM occurrence were 0.75 (95%CI: 0.57-0.93) for ANGPTL-2 and 0.79 (95%CI: 0.61-0.97) for ANGPTL-8, while the combined predictive AUC was 0.81 (95%CI: 0.65-0.91). Conclusions: Serum levels of ANGPTL-2 and ANGPTL-8 in early pregnancy can serve as early predictors for GDM, facilitating the early identification and management of GDM.

Key words: Angiopoietin-like proteins, Blood glucose, Diabetes, gestational, Forecasting, Early diagnosis, Propensity score

张永清, 陈丹青, 陈路萍, 麻芯蕊, 蔡王英, 王美林. 基于倾向性评分匹配探讨妊娠早期空腹血清ANGPTL-2及ANGPTL-8水平预测妊娠期糖尿病的价值[J]. 国际妇产科学杂志, 2024, 51(5): 536-540.

ZHANG Yong-qing, CHEN Dan-qing, CHEN Lu-ping, MA Xin-rui, CAI Wang-ying, WANG Mei-lin. The Value of Early Pregnancy Fasting Serum ANGPTL-2 and ANGPTL-8 Levels in Predicting Gestational Diabetes Mellitus Based on Propensity Score Matching[J]. Journal of International Obstetrics and Gynecology, 2024, 51(5): 536-540.

图/表 4

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组别	n	年龄（岁）	孕次（次）	产次（次）	采集血清时的孕周（周）	采集血清时的 BMI（kg/m²）	OGTT时的 GWG（kg）	FBG （mmol/L）	OGTT-1 h （mmol/L）	OGTT-2 h （mmol/L）
对照组	99	27.1±3.9	2（1，3）	1（0，1）	12.5±0.7	21.9±4.0	6.6±3.7	4.3±0.3	6.8±1.4	5.9±1.1
GDM组	15	29.2±2.9	1（1，4）	0（0，1）	12.5±0.9	22.4±3.1	5.6±1.6	4.8±0.5	9.4±1.5	8.1±1.4
t或Z		-2.015	-0.634	-0.126	-0.005	-0.435	0.987	-4.079	-6.546	-7.011
P		0.046	0.526	0.900	0.996	0.665	0.326	<0.001	<0.001	<0.001

组别	n	年龄（岁）	孕次（次）	产次（次）	采集血清时的孕周（周）	采集血清时的 BMI（kg/m²）	OGTT时的 GWG（kg）	FBG （mmol/L）	OGTT-1 h （mmol/L）	OGTT-2 h （mmol/L）
对照组	99	27.1±3.9	2（1，3）	1（0，1）	12.5±0.7	21.9±4.0	6.6±3.7	4.3±0.3	6.8±1.4	5.9±1.1
GDM组	15	29.2±2.9	1（1，4）	0（0，1）	12.5±0.9	22.4±3.1	5.6±1.6	4.8±0.5	9.4±1.5	8.1±1.4
t或Z		-2.015	-0.634	-0.126	-0.005	-0.435	0.987	-4.079	-6.546	-7.011
P		0.046	0.526	0.900	0.996	0.665	0.326	<0.001	<0.001	<0.001

组别	n	年龄（岁）	孕次（次）	产次（次）	采集血清时的孕周（周）	采集血清时的 BMI（kg/m²）	OGTT时的 GWG（kg）	FBG （mmol/L）	OGTT-1 h （mmol/L）	OGTT-2 h （mmol/L）
对照组	14	29.2±2.8	2（1，4）	0（0，1）	12.3±0.9	24.5±3.6	4.6±2.9	4.3±0.4	6.9±0.9	6.0±0.9
GDM组	14	28.9±2.7	1（1，4）	0（0，1）	12.5±0.9	22.1±3.0	5.6±1.7	4.8±0.5	9.4±1.5	8.0±1.4
t或Z		0.348	-0.592	-0.155	-0.444	1.935	-1.170	-3.062	-5.326	-4.353
P		0.731	0.554	0.877	0.661	0.064	0.253	0.005	<0.001	<0.001

组别	n	年龄（岁）	孕次（次）	产次（次）	采集血清时的孕周（周）	采集血清时的 BMI（kg/m²）	OGTT时的 GWG（kg）	FBG （mmol/L）	OGTT-1 h （mmol/L）	OGTT-2 h （mmol/L）
对照组	14	29.2±2.8	2（1，4）	0（0，1）	12.3±0.9	24.5±3.6	4.6±2.9	4.3±0.4	6.9±0.9	6.0±0.9
GDM组	14	28.9±2.7	1（1，4）	0（0，1）	12.5±0.9	22.1±3.0	5.6±1.7	4.8±0.5	9.4±1.5	8.0±1.4
t或Z		0.348	-0.592	-0.155	-0.444	1.935	-1.170	-3.062	-5.326	-4.353
P		0.731	0.554	0.877	0.661	0.064	0.253	0.005	<0.001	<0.001

项目	年龄	孕次	产次	采集孕周	OGTT时的GWG	采血时BMI	FBG	OGTT-1 h	OGTT-2 h
ANGPTL-2
r	0.083	0.212	0.218	0.042	0.319	0.017	0.537	0.296	0.386
P	0.675	0.279	0.265	0.834	0.098	0.930	0.003	0.126	0.043
ANGPTL-8
r	-0.019	-0.053	0.026	0.064	0.189	-0.261	0.394	0.206	0.291
P	0.924	0.789	0.894	0.745	0.336	0.180	0.038	0.293	0.132