Kumru Pınar, Arisoy Resul, Erdogdu Emre, Demirci Oya, Kavrut Mustecep, Ardıc Cem, Aslaner Nihan, Ozkoral Aysen, Ertekin Aktug
Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey.
Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey.
Taiwan J Obstet Gynecol. 2016 Dec;55(6):815-820. doi: 10.1016/j.tjog.2016.04.032.
We aimed to assess the relationship among the sex hormone-binding globulin (SHBG), homeostasis model assessment (HOMA), glycosylated hemoglobin (HbA1c), and cholesterol panel values to predict subsequent gestational diabetes mellitus (GDM) in low-risk pregnancies.
Thirty-eight pregnant women with GDM and 295 low-risk pregnant women without GDM were included in this study. Maternal blood samples were obtained during the first trimester examination to determine the SHBG, HbA1c, fasting blood glucose, insulin, thyroid stimulating hormone (TSH), free thyroxine, total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol (LDL-C) levels. The variables that exhibited statistically significant differences between the groups and independent predictors for GDM were examined using logistic regression analysis. The risk of developing GDM, according to cutoff values, was determined using receiver operating characteristic (ROC) curve analysis.
The SHBG, HOMA, LDL, and TG levels were found to be the significant independent markers for GDM [adjusted odds ratio (OR) = 0.991; 95% confidence interval (CI), 0.986-995; OR = 1.56; 95% CI, 1.24-1.98; OR = 1.02; 95% CI, 1.01-1.04; and OR = 1.01; 95% CI, 1.00-1.02, respectively]. The HbA1c, body mass index, and mean arterial pressure values were nonindependent predictors of GDM. The areas under the ROC curve used to determine the predictive accuracy of SHBG, HOMA, TG, and LDL-C for development of GDM were 0.73, 0.75, 0.70, and 0.72, respectively. For a false positive rate of 5% for the prediction of GDM, the values of the sensitivities were 21.1, 26.3, 21.1, and 18.4%, respectively.
The HOMA, SHBG, TG, and LDL-C levels are independent predictors for subsequent development of GDM in low-risk pregnancies, but they exhibit low sensitivity.
我们旨在评估性激素结合球蛋白（SHBG）、稳态模型评估（HOMA）、糖化血红蛋白（HbA1c）和胆固醇指标值之间的关系，以预测低风险妊娠中随后发生的妊娠期糖尿病（GDM）。
本研究纳入了38例患有GDM的孕妇和295例无GDM的低风险孕妇。在孕早期检查时采集孕妇血样，以测定SHBG、HbA1c、空腹血糖、胰岛素、促甲状腺激素（TSH）、游离甲状腺素、总胆固醇、甘油三酯（TG）、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇（LDL-C）水平。使用逻辑回归分析检查两组之间表现出统计学显著差异的变量以及GDM的独立预测因素。根据截断值，使用受试者工作特征（ROC）曲线分析确定发生GDM的风险。
发现SHBG、HOMA、LDL和TG水平是GDM的显著独立标志物[调整后的优势比（OR）=0.991；95%置信区间（CI），0.986 - 995；OR = 1.56；95% CI，1.24 - 1.98；OR = 1.02；95% CI，1.01 - 1.04；以及OR = 1.01；95% CI，1.00 - 1.02]。HbA1c、体重指数和平均动脉压值不是GDM的独立预测因素。用于确定SHBG、HOMA、TG和LDL-C对GDM发生的预测准确性的ROC曲线下面积分别为0.73、0.75、0.70和0.72。对于GDM预测的假阳性率为5%时，敏感性值分别为21.1%、26.3%、21.1%和18.4%。
HOMA、SHBG、TG和LDL-C水平是低风险妊娠中随后发生GDM的独立预测因素，但它们的敏感性较低。
