孕早期母体血清血管生成素样蛋白2浓度与妊娠期糖尿病后续风险之间的关联。
Association between Maternal Serum Concentrations of Angiopoietin-like Protein 2 in Early Pregnancy and Subsequent Risk of Gestational Diabetes Mellitus.
作者信息
Zhang Yan, Lu Shan, Li Rong
机构信息
Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.
出版信息
Chin Med J (Engl). 2016 Oct 5;129(19):2308-12. doi: 10.4103/0366-6999.190662.
BACKGROUND
A recent study reported a positive association between elevated serum levels of angiopoietin-like protein 2 (ANGPTL2) and the development of type 2 diabetes in a general population. However, the relationship of serum ANGPTL2 levels with the risk of developing gestational diabetes mellitus (GDM) has not been reported to date. The aim of this study was to investigate the change of maternal serum ANGPTL2 concentrations in the first trimester of pregnancy and to determine whether ANGPTL2 is a biomarker for subsequent GDM development.
METHODS
We conducted a prospective, nested case-control study in a pregnancy cohort. First-trimester ANGPTL2 levels were measured using a high-resolution assay in 89 women who subsequently developed GDM and in a random sample of 177 women who remained euglycemic throughout the pregnancy. Median ANGPTL2 levels were compared using Mann-Whitney U-test. Logistic regression was used to compute unadjusted and multivariable-adjusted odds ratios for developing GDM among ANGPTL2 quartiles.
RESULTS
The serum levels of ANGPTL2 was higher in women with GDM than that in women without GDM (3.06 [2.59, 3.65] ng/ml vs. 2.46 [2.05, 2.96] ng/ml, P = 0.003). Fasting blood glucose was higher in women with GDM than that in women without GDM (5.0 ± 0.9 mmol/L vs. 4.4 ± 0.6 mmol/L, P < 0.001). Glucose challenge test showed that the blood glucose was higher in women with GDM than that in women without GDM (9.1 ± 3.5 mmol/L vs. 6.2 ± 1.2 mmol/L, P < 0.001). A multivariate model adjusted for baseline characteristics, medical complications, and gestational characteristics revealed that the risk of developing GDM among women in Q4 compared with Q1 was 2.90-fold more likely to develop GDM later in pregnancy.
CONCLUSIONS
At 11-13 weeks in pregnancies that develop GDM, the serum concentration of ANGPTL2 is increased, and it can be combined with maternal factors to provide effective early screening for GDM.
背景
最近一项研究报告称，在普通人群中，血清血管生成素样蛋白2（ANGPTL2）水平升高与2型糖尿病的发生呈正相关。然而，血清ANGPTL2水平与妊娠期糖尿病（GDM）发生风险之间的关系迄今尚未见报道。本研究旨在调查妊娠早期孕妇血清ANGPTL2浓度的变化，并确定ANGPTL2是否为后续GDM发生的生物标志物。
方法
我们在一个妊娠队列中进行了一项前瞻性巢式病例对照研究。使用高分辨率检测方法测量了89例随后发生GDM的女性以及177例整个孕期血糖正常的女性的妊娠早期ANGPTL2水平。采用曼-惠特尼U检验比较ANGPTL2水平中位数。使用逻辑回归计算ANGPTL2四分位数中发生GDM的未调整和多变量调整比值比。
结果
GDM女性的血清ANGPTL2水平高于非GDM女性（3.06[2.59, 3.65] ng/ml对2.46[2.05, 2.96] ng/ml，P = 0.003）。GDM女性的空腹血糖高于非GDM女性（5.0±0.9 mmol/L对4.4±0.6 mmol/L，P < 0.001）。葡萄糖耐量试验显示，GDM女性的血糖高于非GDM女性（9.1±3.5 mmol/L对6.2±1.2 mmol/L，P < 0.001）。一个针对基线特征、医学并发症和妊娠特征进行调整的多变量模型显示，与第一四分位数相比，第四四分位数的女性在妊娠后期发生GDM的风险高2.90倍。
结论
在发生GDM的妊娠中，妊娠11 - 13周时血清ANGPTL2浓度升高，它可与母体因素相结合，为GDM提供有效的早期筛查。
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