Maitland R A, Seed P T, Briley A L, Homsy M, Thomas S, Pasupathy D, Robson S C, Nelson S M, Sattar N, Poston L
Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, St. Thomas' Hospital, London, UK.
Diabet Med. 2014 Aug;31(8):963-70. doi: 10.1111/dme.12482. Epub 2014 May 24.
To examine the prediction of gestational diabetes in obese women using routine clinical measures and measurement of biomarkers related to insulin resistance in the early second trimester.
A total of 117 obese pregnant women participating in a pilot trial of a complex intervention of dietary advice and physical activity were studied. Blood samples were obtained at recruitment (15⁺⁰-17⁺⁶ weeks' gestation) and demographic, clinical history and anthropometric measures recorded. The biomarkers analysed were plasma lipids (HDL cholesterol, LDL cholesterol, triglycerides), high-sensitivity C-reactive protein, alanine transaminase, aspartate transaminase, ferritin, fructosamine, insulin, adiponectin, tissue plasminogen activator, interleukin-6, visfatin and leptin. Univariate and logistic regression analyses were performed to determine independent predictors and area under the receiver-operating curve was calculated for the model.
Of the 106 participants included in the analysis, 29 (27.4%) developed gestational diabetes. Participants with gestational diabetes were older (P = 0.002), more often of parity ≥ 2, had higher systolic (P = 0.02) and diastolic blood pressure (P = 0.02) and were more likely to be black (P = 0.009). Amongst the blood biomarkers measured, plasma adiponectin alone remained independently associated with gestational diabetes in adjusted models (P = 0.002). The area under the receiver-operating curve for clinical factors alone (0.760) increased significantly (area under the curve 0.834, chi-square statistic (1) = 4.00, P = 0.046) with the addition of adiponectin.
A combination of routinely measured clinical factors and adiponectin measured in the early second trimester in obese women may provide a useful approach to the prediction of gestational diabetes. Validation in a large prospective study is required to determine the usefulness of this algorithm in clinical practice.
利用常规临床指标及孕中期早期与胰岛素抵抗相关生物标志物的检测，探讨肥胖女性妊娠期糖尿病的预测方法。
对117名参与饮食建议和体育活动综合干预试验的肥胖孕妇进行研究。在招募时（妊娠15⁺⁰-17⁺⁶周）采集血样，并记录人口统计学、临床病史和人体测量指标。分析的生物标志物包括血脂（高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯）、高敏C反应蛋白、丙氨酸转氨酶、天冬氨酸转氨酶、铁蛋白、果糖胺、胰岛素、脂联素、组织型纤溶酶原激活剂、白细胞介素-6、内脂素和瘦素。进行单变量和逻辑回归分析以确定独立预测因素，并计算模型的受试者工作特征曲线下面积。
纳入分析的106名参与者中，29名（27.4%）发生了妊娠期糖尿病。患有妊娠期糖尿病的参与者年龄较大（P = 0.002），多为经产次数≥2次，收缩压（P = 0.02）和舒张压（P = 0.02）较高，且更可能为黑人（P = 0.009）。在所检测的血液生物标志物中，在调整模型中，仅血浆脂联素仍与妊娠期糖尿病独立相关（P = 0.002）。加入脂联素后，仅临床因素的受试者工作特征曲线下面积（0.760）显著增加（曲线下面积0.834，卡方统计量(1)=4.00，P = 0.046）。
肥胖女性在孕中期早期常规测量的临床因素与脂联素相结合，可能为妊娠期糖尿病的预测提供一种有用的方法。需要在大型前瞻性研究中进行验证，以确定该算法在临床实践中的实用性。
