Relationship between serum Hcy, mannose-binding lectin, TyG index, insulin resistance and adverse pregnancy outcomes in patients with gestational diabetes mellitus during the second trimester
10.3760/cma.j.cn431274-20240425-00710
- VernacularTitle:孕中期妊娠期糖尿病患者血清Hcy、甘露聚糖结合凝集素、TyG指数及胰岛素抵抗与不良妊娠结局的关系
- Author:
Yuan XIAO
1
;
Yexin WANG
1
;
Huaqun CHEN
1
;
Lilan WANG
1
;
Wulan CAO
1
Author Information
1. 中山市人民医院产科，中山 528400
- Publication Type:Journal Article
- Keywords:
Diabetes, gestational;
Insulin resistance;
Homocysteine;
Mannose-binding lectin;
Pregnancy outcome
- From:
Journal of Chinese Physician
2024;26(12):1784-1788
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the relationship between serum homocysteine (Hcy), mannose-binding lectin (MBL), triglyceride glucose (TyG) index and homeostasis model assessment-insulinresistance (HOMA-IR) and adverse pregnancy outcomes in patients with second-trimester gestational diabetes mellitus (GDM).Methods:Ninety-eight patients with GDM in the second trimester of pregnancy admitted to the Obstetrics Department of Zhongshan People′s Hospital from April 2020 to June 2022 were retrospectively selected. Serum Hcy and MBL were detected by enzyme-linked immunosorbent assay before intervention, HOMA-IR was evaluated according to homeostasis model, and fasting blood glucose (FBG) was detected by oxidase method. The level of triglyceride (TG) was detected by automatic chemiluminescence immunoassay and TyG index was calculated. The patients were given health education, dietary guidance, insulin and other treatment, followed up until delivery and pregnancy outcomes were recorded. The patients were divided into adverse pregnancy outcome group and no adverse pregnancy outcome group based on pregnancy outcomes. The factors influencing adverse pregnancy outcomes in GDM patients in the second trimester were analyzed, and the predictive value of blood glucose control, serum Hcy, MBL and TyG index on adverse pregnancy outcomes in GDM patients in the second trimester was analyzed by receiver operating characteristics (ROC) curve.Results:After intervention, there were 24 cases (24.49%) of adverse pregnancy outcomes in GDM patients in the second trimester, including 2 cases of polyhydramnios, postpartum hemorrhage, neonatal hypoglycemia, 4 cases of premature membranes breaking, 4 cases of premature delivery, 6 cases of fetal macrosomia, 3 cases of low birth weight, and 1 case of neonatal hyperbilirubinemia. There were statistically significant differences in the proportion of poor glycemic control, Hcy level, TyG index, HOMA-IR and MBL level between the GDM group with adverse pregnancy outcome and the GDM group without adverse pregnancy outcome (all P<0.05). By binary logistic regression analysis, Hcy, TyG index, HOMA-IR and poor glycemic control during pregnancy were risk factors for adverse pregnancy outcomes in GDM patients in the second trimester, and MBL was protective factor for adverse pregnancy outcomes in GDM patients in the second trimester (all P<0.05). The sensitivity of poor glycemic control during pregnancy, Hcy, MBL, TyG index and HOMA-IR alone and in combination to predict adverse pregnancy outcomes of GDM patients in the second trimester were 75.00%, 79.17%, 70.83%, 75.00%, 66.67% and 91.67%, respectively. The specificity was 74.32%, 78.38%, 71.62%, 75.68%, 71.62% and 91.89%, respectively. Poor glycemic control during pregnancy, Hcy, MBL, TyG index and HOMA-IR combined to predict adverse pregnancy outcomes in GDM patients during the second trimester were of high value (all P<0.05). Pearson correlation analysis showed that Hcy and TyG were positively correlated with HOMA-IR ( r=0.712, P<0.001, r=0.649, P=0.023), while MBL was negatively correlated with HOMA-IR ( r=-0.682, P=0.006). Conclusions:Poor glycemic control during pregnancy, Hcy, MBL, TyG index and HOMA-IR are associated with adverse pregnancy outcomes in patients with GDM in the second trimester. Combined detection can predict adverse pregnancy outcomes in patients with GDM in the second trimester early.
