妊娠期糖尿病患者血清连蛋白、水通道蛋白9与糖脂代谢及母婴不良结局的关系

The relationship between serum zonulin, aquaporin 9 levels and glycolipid metabolism, adverse maternal and infant outcomes in pregnant women with gestational diabetes mellitus

摘要

目的 探讨连蛋白(zonulin)、水通道蛋白9(AQP9)在妊娠期糖尿病(GDM)患者血清中的表达水平,以及与糖脂代谢、母婴不良结局的关系。方法 选择2020年6月至2023年3月期间在青岛市妇女儿童医院进行治疗的120例GDM患者(GDM组)作为研究对象,根据母婴结局将其分为良好组(n=64)和不良组(n=56);另选取120例健康孕妇作为对照组.比较各组间血清zonulin、AQP9、糖脂代谢水平;Pearson相关法分析血清zonulin、AQP9水平分别与空腹血糖(FBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)的相关性;受试者工作特征(ROC)曲线分析血清zonulin、AQP9水平对GDM患者母婴不良结局的预测价值。结果 与对照组相比,GDM组血清zonulin、AQP9、FBG、FINS、HOMA-IR、HbA1c、TC、TG、LDL-C水平升高,HDL-C水平降低,差异均有统计学意义(t值介于8.645~33.532之间,P<0.05);母婴结局不良组血清zonulin、AQP9、FBG、FINS、HOMA-IR、HbA1c、TC、TG、LDL-C水平高于良好组,HDL-C水平低于良好组,差异均有统计学意义(t值介于5.327~9.452之间,P<0.05);血清zonulin、AQP9水平分别与FBG、FINS、HOMA-IR、TC、TG、LDL-C呈正相关性(r值介于0.442~0.684之间,P<0.05);血清zonulin、AQP9水平分别与HDL-C呈负相关性(r值分别为-0.582、-0.494,P<0.05);血清zonulin、AQP9联合预测GDM患者母婴不良结局的曲线下面积(AUC)为0.947,二者联合预测优于单独预测(Z值分别为3.098、2.131,P<0.05)。结论 GDM患者血清zonulin、AQP9水平显著升高,与糖脂代谢密切相关,两者联合预测GDM患者母婴不良结局具有较高的价值.

Abstract

Objective To investigate the serum expression levels of zonulin and aquaporin 9 (AQP9) in patients with gestational diabetes mellitus (GDM) and the relationship with glycolipid metabolism and adverse maternal and neonatal outcomes. Methods A total of 120 GDM patients treated at Qingdao Women and Children's Hospital from June 2020 to March 2023 were enrolled as the GDM group. Based on maternal and neonatal outcomes, they were further divided into the favorable outcome group (n=64) and the adverse outcome group (n=56). Additionally, 120 healthy pregnant women were included as the control group. Serum levels of zonulin, AQP9, and glycolipid metabolism indicators were compared among groups. Pearson correlation analysis was used to assess the correlations of serum zonulin and AQP9 levels with fasting blood glucose (FBG), fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR), glycated hemoglobin (HbA1c), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of serum zonulin and AQP9 levels for adverse maternal and neonatal outcomes in GDM patients. Results Compared with the control group, the GDM group showed significantly elevated serum levels of zonulin, AQP9, FBG, FINS, HOMA-IR, HbA1c, TC, TG, and LDL-C, while HDL-C levels were significantly decreased (t value ranged from 8.645 to 33.532, P<0.05). The adverse outcome group exhibited higher serum levels of zonulin, AQP9, FBG, FINS, HOMA-IR, HbA1c, TC, TG, and LDL-C, and lower HDL-C levels than the favorable outcome group, with statistically significant differences (t value ranged from 5.327 to 9.452, P<0.05). Serum zonulin and AQP9 levels were positively correlated with FBG, FINS, HOMA-IR, TC, TG, and LDL-C (r value ranged from 0.442 to 0.684, P<0.05), and negatively correlated with HDL-C (r=-0.582 and -0.494, respectively, P<0.05). The combined prediction of adverse maternal and neonatal outcomes using serum zonulin and AQP9 levels had an area under the curve (AUC) of 0.947, which was superior to the predictive ability of either marker alone (Z=3.098 and 2.131, respectively, P<0.05). Conclusion Serum levels of zonulin and AQP9 are significantly elevated in GDM patients and are closely associated with glycolipid metabolism. The combined detection of zonulin and AQP9 provides high predictive value for adverse maternal and neonatal outcomes in GDM patients.

关键词

连蛋白 / 水通道蛋白9 / 妊娠期糖尿病 / 糖脂代谢 / 母婴不良结局

Key words

zonulin / aquaporin 9 / gestational diabetes mellitus / glycolipid metabolism / adverse maternal and infant outcome

参考文献

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基金资助

青岛市卫生和计划生育委员会指导计划项目(2017GWJZD113)