|
|
|
| Interactive Effect and Combined Predictive Value of Serum SHBG and FABP4 Levels in the Risk of Preterm Delivery in Patients with Gestational Diabetes Mellitus |
| YANG Juehong, ZHANG Chongjie, DING Tingping, et al |
| Yuncheng Central Hospital, Shanxi Medical University, Shanxi Yuncheng 044000, China |
|
|
|
|
Abstract Objective: To explore the interactive effect and combined predictive value of serum sex hormone binding globulin (SHBG) and fatty acid binding protein 4 (FABP4) levels in the risk of premature delivery in patients with gestational diabetes mellitus (GDM). Methods: 209 GDM patients from Yuncheng Central Hospital Affiliated to Shanxi Medical University from June 2021 to June 2024 were selected as the research subjects. They were assigned to premature group (65 cases) and full-term group (144 cases) according to whether premature delivery occurred. Serum SHBG and FABP4 levels were detected in fasting peripheral venous blood drawn early in the morning of the day following the diagnosis of GDM (before any glucose-lowering intervention) in all patients, the levels of serum SHBG and FABP4 were compared between the two groups, serum SHBG and FABP4 levels were classified into high and low levels based on the median and accordingly divided into four subgroups. The clinical data and premature delivery rates of the four subgroups were compared. The relationship and interactive effect between serum SHBG, FABP4 and the risk of premature delivery were analyzed. The predictive value of serum SHBG and FABP4 for the risk of premature delivery was evaluated. Results: The serum SHBG level in the preterm group was (332.61±75.93) nmoL/L, significantly lower than that in the full-term group [(428.38±108.74) nmoL/L], while the FABP4 level [(28.55±8.13) μg/L] was significantly higher than that in the full-term group [(20.93±6.52) μg/L] (P<0.05). There were statistically significant differences in pre-pregnancy BMI, gestational weight gain, history of adverse pregnancy, fasting blood glucose (FBG), 1-hour postprandial blood glucose (1h PBG), 2-hour postprandial blood glucose (2h PBG), and preterm birth rate among the four subgroups (P<0.05). Before and after adjusting for other factors, serum SHBG and FABP4 levels were independent influencing factors for preterm birth risk in GDM patients (P<0.05). Before adjusting for other factors, compared with the Q1 subgroup, the odds ratios (OR) [95% confidence interval (CI)] for preterm birth risk in GDM patients in the Q2, Q3, and Q4 subgroups were 3.125 (1.186~8.234), 3.114 (1.224~7.920), and 6.024 (2.451~14.806), respectively. After adjusting for other factors, the OR (95%CI) for preterm birth risk in the Q2, Q3, and Q4 subgroups were 2.929 (1.152~7.449), 2.785 (1.103~7.031), and 5.428 (2.216~13.297), respectively. Interaction analysis showed a positive interaction between low SHBG levels and high FABP4 levels in the risk of preterm birth in GDM patients (P<0.05). The area under the receiver operating characteristic curve (AUC) for serum SHBG and FABP4 in predicting preterm birth risk in GDM patients was 0.760 and 0.755, with sensitivity of 80.00% and 83.08%, and specificity of 65.28% and 60.42%, respectively. The combined prediction model had an AUC of 0.887, sensitivity of 84.62%, and specificity of 85.42%, which was significantly better than the individual predictive values of the two markers (Z=3.011, 2.781; P=0.003, 0.005). Conclusion: Low serum SHBG expression and high FABP4 expression exhibit a positive interaction in the risk of preterm birth in GDM patients, serving as independent influencing factors. The combined prediction model demonstrates reliable predictive value for preterm birth risk in GDM patients.
|
|
|
|
|
|
[1] Wicklow B,Retnakaran R.Gestational diabetes mellitus and its implications across the life span[J].Diabetes Metab,2023,47(3):333-344.
[2] Malaza N,Masete M,Adam S,et al.A systematic review to compare adverse pregnancy outcomes in women with pregestational diabetes and gestational diabetes[J].Int Environ Res Public Health,2022,19(17):10846.
[3] Huang R,Wang Y,Yan RN,et al.Sex hormone binding globulin is an independent predictor for insulin resistance in male patients with newly diagnosed type 2 diabetes mellitus[J].Diabetes Ther,2023,14(10):1627-1637.
[4] 谢幸,孔北华,段涛.妇产科学[M].第9版.北京:人民卫生出版社,2018.106-109.
[5] Berger H,Gagnon R,Sermer M.Guideline No.393-diabetes in pregnancy[J].Obstet Gynaecol Can,2019,41(12):1814-1825.
[6] Hedderson MM,Capra A,Lee C,et al.Longitudinal changes in sex hormone binding globulin (SHBG) and risk of incident diabetes:the study of women's health across the nation (SWAN)[J].Diabetes Care,2024,47(4):676-682.
[7] 罗剑波,邓洁.孕早期性激素结合球蛋白、炎症因子及血脂水平与妊娠期糖尿病的关系分析[J].标记免疫分析与临床,2018,25(1):73-77.
[8] Basil B,Oghagbon EK,Mba IN,et al.First trimester sex hormone-binding globulin predicts gestational diabetes mellitus in a population of Nigerian women[J].Obstet Gynaecol,2022,42(7):2924-2930.
[9] Trojnar M,Patro-Matysza J,Kimber-Trojnar Z,et al.Associations between fatty acid-binding protein 4-A proinflammatory adipokine and insulin resistance, gestational and type 2 diabetes mellitus[J].Cells,2019,8(3):227.
[10] 赵海歌,梁淑新,赵雅堃,等.人吻素1、脂肪酸结合蛋白质4与糖脂代谢指标的相关性分析及其对妊娠糖尿病的早期诊断价值[J].检验医学与临床,2024,21(11):1595-1599,1605.
[11] Ron I,Mdah R,Zemet R,et al.Adipose tissue-derived FABP4 mediates glucagon-stimulated hepatic glucose production in gestational diabetes[J].Diabetes Obes Metab,2023,25(11):3192-3201.
[12] Ruszata M,Pilszyk A,Niebrzydowska M,et al.Novel biomolecules in the pathogenesis of gestational diabetes mellitus 2.0[J].Int Mol Sci,2022,23(8):4364.
[13] 苏立,邸丽萍,李雪.孕早期血清FABP4水平与妊娠期糖尿病和早产风险的关系研究[J].广西医科大学学报,2022,39(7):1118-1124. |
|
|
|
2025, Vol. 31 
