| Research backgroundThe incidence of gestational diabetes mellitus(GDM)is increasing in my country,and insulin resistance and decreased islet β-cell function secretion are important links in the pathogenesis of diabetes.Adipokine regulates body metabolism in various ways,and also has the function of inflammation and immune regulation.It can act on the insulin-mediated signal transduction pathway and affect the glucose and lipid metabolism of diabetic patients through the action of different targets.Adiponectin is currently the most widely studied of all adipokines.In healthy people,adiponectin plays an important role in preventing blood vessel changes,abnormal glucose tolerance and abnormal lipid metabolism.Visfatin plays an important role in insulin resistance and related diseases such as diabetes and metabolic syndrome.It can affect blood glucose levels and regulate glucose metabolism by increasing the glucose uptake capacity of fat and muscle tissues and reducing the release of glucose from the liver.This trial intends to observe the relationship between serum adiponectin,visfatin and insulin resistance in early pregnancy of GDM patients,and analyze whether adiponectin and visfatin in early pregnancy can be used as useful indicators for predicting GDM and lay the experimental foundation for early prevention and treatment of GDM.OBJECTIVETo observe the relationship between serum adiponectin,visfatin and insulin resistance in patients with GDM at early pregnancy,and analyze whether serum adiponectin and visfatin at early pregnancy can be used as useful indexes to predict GDM so as to provide theoretical guidance for early prevention and treatment of GDM.MethodsPregnant women with high-risk factors who completed regular prenatal examinations in the outpatient clinic from April 2017 to March 2020 were enrolled in the study.They were grouped into the experimental group(pregnant women with GDM)and the control group(pregnant women with normal OGTT results)according to the oral glucose tolerance test(OGTT)results at 24 ～ 28 weeks of gestation.The final OGTT results showed that there were 150 patients with GDM in the experimental group and 150 normal pregnant women were selected as the control group according to the ratio of 1: 1.Height and weight at early pregnancy were collected.The body mass index(BMI)and waist-to-hip ratio(WHR)were calculated.The standard mercury sphygmomanometer was used to measure blood pressure,and gravidity and parity were recorded.Blood samples of both groups of pregnant women were collectedand then serum was separated.The automatic electrochemiluminescence immunoassay analyzer was used to determine levels of blood lipids [triacylglycerol(TG),total cholesterol(TC),low density lipoprotein-cholesterol(LDL-C),high density lipoprotein-cholesterol(HDL-C)],fasting blood glucose(FBG)and 2h postprandial plasma glucose(2h PG).The radioimmunoassay was used to determine the fasting insulin(FINS)levels.The insulin resistance index(HOMA-IR)= FBG × FINS / 22.5 was calculated according to the HOMA model.Serum adiponectin and visfatin levels were detected by enzyme-linked immunoassay.Multivariate Logistic regression analysis was performed to analyze the risk factors affecting the incidence of GDM,and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum adiponectin and visfatin in predicting the incidence of GDM.Results(1)The age,BMI,TG,LDL-C,FBG,2h PG,FINS,visfatin and HOMA-IR levels in the experimental group were significantly higher than those in the control group,and serum adiponectin levels were significantly lower than the control group(P<0.05).(2)Pearson correlation analysis results show that there was no correlation between serum adiponectin and age,TC,HDL-C levels in patients with GDM(P>0.05),but it was significantly negatively correlated with BMI,TG,LDL-C,FBG,2h PG,FINS and HOMA-IR(P<0.05).There was no correlation between serum visfatin and age,TC,HDL-C levels in patients with GDM(P>0.05),but it was significantly positively correlated with BMI,TG,LDL-C,FBG,2h PG,FINS and HOMA-IR(P<0.05).Multiple linear stepwise regression analysis was performed using HOMA-IR as the dependent variable and various related factors as independent variables.The results showed that BMI,TG,LDL-C,FBG,2h PG,FINS,serum adiponectin and visfatin levels are related to insulin resistance(P<0.05).(3)With GDM as the dependent variable,age,gravidity,parity,BMI,WHR,blood pressure,glucose and lipid metabolism,serum adiponectin,visfatin levels and HOMA-IR as independent variables,multivariate Logistic regression analysis results showed that BMI,TG,LDL-C,FBG,2h PG,FINS,serum visfatin levels and HOMA-IR were independent risk factors for GDM,while serum adiponectin levels were independent protective factors of GDM(P<0.05).(4)ROC curve analysis results show that the areas under the ROC curves of serum adiponectin and visfatin for predicting the incidence of GDM were 0.883 and0.731,respectively.The sensitivities were 72.7% and 84.7%,respectively,and the specificities were 86.0% and 54.0%,respectively.The area under the curve,sensitivity and specificity of the combined prediction were 0.878,80.0% and 80.7%,respectively.The value of combined prediction was significantly higher than the single prediction of serum adiponectin or visfatin alone.Conclusion:(1)Serum adiponectin levels were significantly decreased and serum visfatin levels were significantly elevated in patients with GDM at early pregnancy.(2)Serum adiponectin levels were significantly negatively correlated with HOMA-IR,but was significantly positively correlated with HOMA-IR in patients with GDM.(3)BMI,TG,LDL-C,FBG,2h PG,FINS,serum visfatin levels and HOMA-IR are independent risk factors affecting the incidence of GDM,and serum adiponectin levels are independent protective factors influencing the incidence of GDM.(4)Serum adiponectin and visfatin can be used to predict the onset of GDM at early pregnancy,and the predictive value of the combination of the two is higher.They can guide the clinical screening of GDM,thus helping to take intervention measures in advance,reducing the risk of complications,and improving the maternal and neonatal outcomes. |
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