Relation Of Serum Secreted Frizzled-related Protein 5 To Overweight And Gestational Diabetes Mellitus

BackgroundGestational diabetes mellitus is a pregnancy specific complication which is a temporary glucose metabolism abnormality induced by pregnancy.The increase of blood glucose during pregnancy is closely related to the occurrence of adverse pregnancy outcomes,especially the serious GDM.In recent years,researches about the etiology of GDM have been recognized,but the cause has not yet fully elucidated.GDM is a multi-factorial disease.The pathogeny is considered to be a combination of genetic factors,insulin resistance,inflammatory factors,and cytokines.Serum frizzled-related protein 5 is a novel adipokine.It can compete with Frizzled protein receptor for Wnt ligand and negatively regulate Wnt pathway.Wnt signaling pathway is an important cell signaling network.Its function is most common in embryonic development and cancer.It plays an important role in cell growth,differentiation,metabolism and apoptosis,and is also involved in the normal physiological process of human beings.The problem of regulation and control of Wnt pathway is closely related to the occurrence and progress of diseases such as cancer,obesity and diabetes.The study of Sfrp-5 mainly focuses on cancer and type II diabetes.So far,there is few studies on Sfrp-5 in pregnant women and the relationship between Sfrp-5 and GDM.ObjectiveTo investigate the serum secreted frizzled-related protein 5(Sfrp-5)level among gestational diabetes mellitus(GDM)and normal glucose tolerance(NGT)pregnant women,and to explore the relationship among Sfrp-5 and overweight and insulin resistance,as well as GDM.Materials and methods106 pregnant women with gestational week between 24-28 weeks were included,53 of them were NGT and others were diagnosed as GDM.All the cases were divided into normal weight(NW)group and overweight(OW)group according to pre-pregnant body mass index(BMI).The level of serum Sfrp-5 were detected by enzyme-linked immunosorbent assay(ELISA).The blood glucose,lipid,fasting insulin(FINS)and homeostasis model assessment insulin resistance index(HOMA-IR)were also determined.Result(1)The Sfrp-5 level of GDM group was statistically lower than NGT group [(2.582±1.116)ng/ml vs.(5.263±1.550)ng/ml,P<0.05].In both NGT group and GDM group,the OW subgroup had lower serum Sfrp-5 concentrations than the NW subgroup [(4.353±1.291)ng/ml vs.(5.498±1.533)ng/ml,(2.896±0.987)ng/ml vs.(2.166±1.144)ng/ml,P<0.05],and the serum Sfrp-5 level of GDM-OW subgroup was significantly lower than that of NGT-OW subgroup [(4.353±1.291)ng/ml vs.(2.166±1.144)ng/ml,P<0.05].(2)Correlation analysis showed that serum Sfrp-5 levels were positively correlated with HDL and negatively correlated with FPG,FINS,HOMA-IR,CHOL,LDL(P<0.01 or P<0.05).(3)Multiple stepwise regression showed that FPG,FINS,HOMA-IR were independent influencing factors of serum Sfrp-5(P<0.01).(4)Logistic regressions showed the level of Sfrp-5 was related to insulin resistance and GDM [(P<0.01),OR<1].(5)Serum Sfrp-5 level has a certain ability to recognize GDM(AUC=0.875,P<0.01).When the cutoff value of serum Sfrp-5 is 3.15ng/ml,there is a high sensitivity(0.91)and specificity(0.76)ConclusionsSerum Sfrp-5 is closely related to GDM.Sfrp-5 expression in overweight and GDM patients coexist with insulin resistance and glucose-lipid metabolic disorder,and Sfrp-5 decline is more obvious when patients are overweight and GDM.