糖化纤维连接蛋白作为预测妊娠期糖尿病的早期标志物。

Glycosylated fibronectin as a first-trimester biomarker for prediction of gestational diabetes.

机构信息

Department of Obstetrics, Oregon Health and Science University, Portland, Oregon, USA.

出版信息

Obstet Gynecol. 2013 Sep;122(3):586-94. doi: 10.1097/AOG.0b013e3182a0c88b.

DOI:10.1097/AOG.0b013e3182a0c88b

PMID:23921871

Abstract

OBJECTIVE

To evaluate the potential clinical utility of serum biomarkers for first-trimester prediction of gestational diabetes mellitus (GDM).

METHODS

Maternal serum concentrations of glycosylated (Sambucus nigra lectin-reactive) fibronectin, adiponectin, sex hormone-binding globulin, placental lactogen, and high-sensitivity C-reactive protein (CRP) were measured at 5-13 weeks of gestation in a case-control study of 90 pregnant women with subsequent development of GDM and in 92 control group participants. Ability to detect GDM was assessed using logistic regression modeling and receiver operating characteristic (ROC) curves. Classification performance and positive and negative predictive values were reported at specific thresholds. Glycosylated fibronectin variation across trimesters was evaluated using a serial-measures analysis of 35 nondiabetic control group participants.

RESULTS

First-trimester serum concentrations of glycosylated fibronectin, adiponectin, high-sensitivity CRP, and placental lactogen were significantly associated (P<.001) with GDM. After adjustment for maternal factors and other biomarkers, glycosylated fibronectin demonstrated an independent association with GDM (P<.001). Adiponectin, high-sensitivity CRP, and placental lactogen demonstrated modest classification performance compared with glycosylated fibronectin (respectively: area under the curve [AUC] 0.63; 95% confidence interval [CI] 0.53-0.71; AUC 0.68; 95% CI 0.60-0.76; and AUC 0.67, 95% CI 0.59-0.75; compared with AUC 0.91; 95% CI 0.87-0.96). Glycosylated fibronectin levels above a threshold of 120 mg/L correctly identified 57 GDM case group participants with a positive predictive value of 63% (95% CI 53-72%) and a negative predictive value of 95% (95% CI 94-95%) at a population prevalence of 12%. There was no association between sex hormone-binding globulin and GDM.

CONCLUSION

First-trimester glycosylated fibronectin is a potential pregnancy-specific biomarker for early identification of women at risk for GDM.

LEVEL OF EVIDENCE

II.

摘要

目的

评估血清生物标志物在预测妊娠糖尿病（GDM）中的潜在临床应用价值。

方法

采用病例对照研究，在 90 名随后发生 GDM 的孕妇和 92 名对照组参与者中，在 5-13 孕周时测量了血清中糖化（黑接骨木凝集素反应性）纤维连接蛋白、脂联素、性激素结合球蛋白、胎盘催乳素和高敏 C 反应蛋白（CRP）的浓度。使用逻辑回归模型和受试者工作特征（ROC）曲线评估检测 GDM 的能力。报告了特定阈值下的分类性能以及阳性和阴性预测值。使用 35 名非糖尿病对照组参与者的系列测量分析评估了糖化纤维连接蛋白在各孕期的变化。

结果

妊娠早期血清中糖化纤维连接蛋白、脂联素、高敏 CRP 和胎盘催乳素浓度与 GDM 显著相关（P<.001）。在校正了母体因素和其他生物标志物后，糖化纤维连接蛋白与 GDM 具有独立相关性（P<.001）。与糖化纤维连接蛋白相比，脂联素、高敏 CRP 和胎盘催乳素的分类性能较差（分别为 AUC 0.63；95%CI 0.53-0.71；AUC 0.68；95%CI 0.60-0.76；AUC 0.67，95%CI 0.59-0.75；与 AUC 0.91；95%CI 0.87-0.96）。在人群患病率为 12%时，将糖化纤维连接蛋白水平超过 120mg/L 作为阈值，可正确识别 57 名 GDM 病例组参与者，阳性预测值为 63%（95%CI 53-72%），阴性预测值为 95%（95%CI 94-95%）。性激素结合球蛋白与 GDM 之间没有关联。