The Influence And Predictive Value Of Serum CTRP1 And CTRP9 In Early Pregnancy On Insulin Resistance And Gestational Diabetes

Objectives:1 To investigate the relationship between serum CTRP1 and CTRP9 in early pregnancy and insulin resistance and isletβcell function,and to provide a theoretical basis for the mechanism of CTRP1 and CTRP9 in regulating glucose and lipid metabolism.2 To investigate the relationship between serum CTRP1 and CTRP9 in early pregnancy and GDM,and to provide clinical evidence for the study of the etiology and pathogenesis of GDM.3 To explore the predictive value of CTRP1 and CTRP9 for GDM,and provide new ideas for further improving the early prediction model of GDM.Methods:A prospective study method was used to select women who met the criteria of 6～14 weeks of pregnancy in the obstetric clinic,and fill out the questionnaire,including demographic characteristics such as age,occupation,past history and family history.The height,weight and blood pressure were measured.Fasting venous blood was collected to detect fasting plasma glucose（FPG）,glycosylated hemoglobin A1c（Hb A1c）,fasting insulin（FINS）,total cholesterol（TC）,triglyceride（TG）,high density lipoprotein cholesterol（HDL-C）,low density lipoprotein cholesterol（LDL-C）and other metabolic indicators.Enzyme-linked immunosorbent assay was used to detect serum CTRP1 and CTRP9 concentrations.GDM was screened by 75 g OGTT at 24～28 weeks of gestation.SPSS26.0 was used to establish the database and statistical analysis.The Kolmogorov-Smirnov method was used to test the normality of continuous variables,the variables with normal distribution were described,and the variables with non-normal distribution were described by M(P₂₅～P₇₅).Two independent sample t test or Mann-Whitney U test was used for comparison between groups.The classification variables are described by composition ratio or rate,and the comparison between groups is performed byχ² test.Spearman correlation coefficient is used to describe the correlation between quantitative indicators.Multiple linear regression analysis was used to analyze the effect of CTRP1 and CTRP9on insulin resistance and isletβcell function.Binary logistic stepwise regression analysis was used to analyze the influencing factors of GDM,and the prediction model of GDM was constructed.The ROC curve was drawn,and the AUC and its 95%confidence interval were calculated,and the sensitivity and specificity of single index or model in predicting GDM were estimated.The AUC of different prediction methods was tested by De-long test using Med Calc19.0.Results:1 The relationship between serum CTRP1,CTRP9 and maternal BMI and glucose and lipid metabolism indexes in early pregnancy:（1）In NGT pregnant women,CTRP1 was positively correlated with BMI,SBP,DBP,TC,TG and LDL-C at admission（P<0.05）,but there was no significant correlation between GDM pregnant women and human measurement indexes,glucose and lipid metabolism indexes（P>0.05）.2 The relationship between serum CTRP1 and CTRP9 in early pregnancy and insulin resistance and isletβcell function:（1）In NGT pregnant women,CTRP1 was positively correlated with FINS,HOMA-IR and HOMA-β,and CTRP1 was an independent influencing factor of lg HOMA-IR（P<0.05）.（2）In NGT pregnant women and GDM pregnant women,serum CTRP9 in early pregnancy was negatively correlated with FINS,HOMA-IR and HOMA-β,and CTRP9 was an independent influencing factor of lg HOMA-IR（P<0.05）.In GDM pregnant women,serum CTRP9 is an independent influencing factor of lg HOMA-β.3 The relationship between maternal characteristics and GDM in early pregnancy:（1）The age,BMI,SBP,FPG,Hb A1c,FINS,HOMA-IR,HOMA-β,TC,TG and LDL-C of GDM pregnant women were higher than those of NGT pregnant women,and the differences were statistically significant（P<0.05）;There was no significant difference in gestational age,DBP and HDL-C between GDM pregnant women and NGT pregnant women（P>0.05）.The previous pregnancy and previous parity of GDM pregnant women were higher than those of NGT pregnant women,and the differences were also statistically significant（P<0.05）.However,there was no significant difference in the proportion of previous history of gestational hypertension and PCOS between GDM pregnant women and NGT pregnant women（P>0.05）.（2）Binary logistic stepwise regression analysis showed that age,FPG,FINS,Hb A1c,TG and family history of DM were associated with GDM（P<0.05）.4 The relationship between serum CTRP1,CTRP9 and GDM in early pregnancy:（1）The serum CTRP1 level of GDM pregnant women in early pregnancy was 121.20（106.92～135.90）ng/ml,which was higher than115.80（103.56～130.71）ng/ml of NGT pregnant women,and the difference was statistically significant（z=1.912,P=0.056）;（2）The serum CTRP9level of GDM pregnant women[2059.20（1543.40～2855.70）ng/ml]was lower than that of NGT pregnant women[2639.40（1756.50～4062.50）ng/ml],the difference was statistically significant（z=3.239,P=0.001）.（3）The results of binary logistic regression analysis showed that there was no significant correlation between CTRP1 and GDM（P>0.05）,and the OR（95%CI）was 1.161（0.935～1.443）.The correlation between CTRP9 and GDM was statistically significant（P<0.05）,and the OR（95%CI）was 0.695（0.557～0.867）.After adjusting for age and BMI,the association between CTRP1and GDM was not statistically significant（P>0.05）,and the OR（95%CI）was 1.094（0.861～1.391）.The association between CTRP9 and GDM was still statistically significant（P<0.05）,and its OR（95%CI）was 0.772（0.602～0.989）.5 Predictive value of single glucose and lipid metabolism index in early pregnancy for GDM:AUC of FPG was 0.699（95%CI:0.631～0.767）,sensitivity of cutoff point was 4.99 mmol/L was 48.35%,and specificity was86.83%;AUC of Hb A1c was 0.682（95%CI:0.621～0.743）,sensitivity of 4.85%was 70.33%,and specificity was 53.03%;The AUC of FINS was0.670（95%CI:0.607～0.733）,the sensitivity was 70.33%and the specificity was 53.03%when the cutoff point was 6.91 m IU/L.The AUC of TG was 0.657（95%CI:0.594～0.721）,the sensitivity was 64.84%and the specificity was 62.63%when the cutoff point was 1.44 mmol/L.The AUC of Ty G was 0.690（95%CI:0.629～0.752）.There was no significant difference in AUC of the five indicators（P>0.05）.6 The predictive value of maternal characteristic model,serum CTRP9and combined prediction model for GDM:AUC of maternal characteristic model was 0.833（95%CI:0.785～0.882）,sensitivity was 54.94%,specificity was 95.02%;The AUC of serum CTRP9 was 0.613（95%CI:0.550～0.676）,the sensitivity was 76.51%and the specificity was 36.32%at the cutoff point of 1697.6 ng/m L;The AUC of serum CTRP9 combined with age and BMI was 0.773（95%CI:0.714～0.831）,the sensitivity was29.67%and the specificity was 95.73%.Conclusions:1 Maternal serum CTRP1 in early pregnancy is related to insulin resistance,but it is not an independent influencing factor of GDM.2 Maternal serum CTRP9 in early pregnancy may be involved in GDM by affecting insulin resistance and isletβcell function.Maternal serum CTRP9 in early pregnancy may be involved in the development of GDM by reducing insulin resistance and inhibiting isletβ-cell function.3 Maternal serum CTRP9 in early pregnancy has potential GDM prediction efficacy,but its prediction value is limited.