孕早期血红蛋白联合免疫炎症指标预测妊娠期糖尿病的临床价值

The clinical value of first-trimester hemoglobin and immune-inflammatory markers in predicting gestational diabetes mellitus

摘要

目的 分析孕早期血红蛋白（hemoglobin,Hb）水平、常见免疫炎症指标对妊娠期糖尿病（gestational diabetes mellitus,GDM）的预测价值。方法 回顾性收集哈尔滨医科大学附属第一医院2024年1—12月规律产检的孕妇368例。检测孕早期（8~13⁺⁶周）Hb及C反应蛋白（C-reactive protein,CRP）、降钙素原（procalcitonin,PCT）、中性粒细胞淋巴细胞比值（neutrophil-to-lymphocyte ratio,NLR）、血小板淋巴细胞比值（platelet-to-lymphocyte ratio,PLR）、单核细胞淋巴细胞比值（monocyte-to-lymphocyte ratio,MLR）。根据孕24~28周时口服葡萄糖耐量试验是否诊断为GDM,将孕妇分为GDM组56例（15.22%）和非GDM组312例（84.78%）。采用Logistic回归模型分析Hb及炎症指标与GDM的相关性,并采用受试者工作特征（receiver operating characteristic,ROC）曲线判断其对GDM的预测价值。结果 与非GDM组比较,GDM组Hb[（143.37±8.67） g/L vs. （137.69±7.72） g/L]、CRP[（2.33±0.91） mg/L vs. （2.12±0.63） mg/L]、NLR（3.69±0.84 vs. 3.42±0.76）、MLR（0.45±0.21 vs. 0.30±0.18）显著升高（P<0.05）。校正了孕前体重指数（body mass index,BMI）、糖尿病家族史、首次产检空腹血糖后,Logistic回归模型发现Hb（OR=1.704,95%CI：1.157~2.509）、MLR（OR=2.164,95%CI：1.335~3.508）升高是GDM的独立危险因素。ROC曲线显示,Hb联合MLR预测GDM的AUC为0.880（95%CI：0.829~0.931）,敏感度为78.57%,特异度为86.56%,预测效能优于单一Hb[AUC：0.726（95%CI：0.654~0.798）]、MLR[AUC：0.765（95%CI：0.697~0.833）]。结论 孕早期Hb和MLR升高是GDM的独立危险因素,二者联合应用对GDM具有较好的辅助预测价值。

Abstract

Objective To analyze the predictive value of first-trimester hemoglobin （Hb） levels and common immune-inflammatory markers for gestational diabetes mellitus （GDM）. Methods This was a retrospective study based on medical records, involving 368 pregnant women who had regular prenatal check-ups from January 2024 to December 2024. The main study indicators were hemoglobin （Hb）, C-reactive protein （CRP）, procalcitonin （PCT）, neutrophil-to-lymphocyte ratio （NLR）, platelet-to-lymphocyte ratio （PLR）, and monocyte-to-lymphocyte ratio （MLR） in the first trimester （8 to 13⁺⁶ weeks of gestation）. According to the diagnosis of GDM based on the oral glucose tolerance test （OGTT） at 24―28 weeks of gestation, the pregnant women were divided into a GDM group （n=56, 15.22%） and a non-GDM group （n=312, 84.78%）. Logistic regression models were used to analyze the correlation of Hb and inflammatory markers with GDM, and receiver operating characteristic （ROC） curves were used to determine their predictive value for GDM. Results Compared with the non-GDM group, the GDM group had significantly higher Hb [（143.37±8.67） g/L vs. （137.69±7.72） g/L], CRP [（2.33±0.91） mg/L vs. （2.12±0.63） mg/L], NLR （3.69±0.84 vs. 3.42±0.76）, and MLR （0.45±0.21 vs. 0.30±0.18） （P<0.05）. After adjusting for pre-pregnancy body mass index （BMI）, family history of diabetes, and fasting blood glucose at the first prenatal check-up, logistic regression models revealed that Hb （OR=1.704, 95%CI： 1.157―2.509） and MLR （OR=2.164, 95%CI： 1.335―3.508） were independently associated with GDM. The ROC curve showed that the combination of Hb and MLR had an AUC of 0.880 （95%CI： 0.829―0.931） for predicting GDM, with a sensitivity of 78.57% and a specificity of 86.56%, which was superior to the predictive performance of Hb [AUC： 0.726 （95%CI： 0.654―0.798）] or MLR alone [AUC： 0.765 （95%CI： 0.697―0.833）]. Conclusion Elevated Hb and MLR in the first trimester are independent risk factors for GDM, and their combined application has a good auxiliary predictive value for GDM.

关键词

糖尿病,妊娠 / 血红蛋白 / 免疫

Key words

diabetes,gestational / hemoglobin / immunity