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目的:对肿瘤坏死因子α和C反应蛋白(CRP)及相关细胞因子与妊娠期糖尿病(GDM)发病的情况相关性分析。方法:选取2011~2013年延边大学附属医院门诊进行孕检的妊娠期女性11例,分为口服糖耐量试验(OGTT)正常组(NGT组)30例,OGTT糖耐量受损组(IGTT组)40例,OGTT糖尿病组(GDM组)40例。所有检测孕妇均抽取空腹静脉血4 ml,离心分离血清,3 000 r/min,然后保存在低温冰箱内。TNF-α检测采用双抗体夹心酶联法测定,CRP采用速度散射比浊法测定,脂联素采用ELISA法测定,采用全自动时间分辨分析法测定胰岛素水平,葡萄糖氧化酶法测定孕妇血糖水平。结果:3组妇女不同时间的细胞因子TNF-α、CRP和HOMA-IR比较,GDM组和IGGT组明显低于NGT组,而脂联素却高于NGT组。通过细胞因子水平的相关性及多元线性回归分析显示,TNF-α水平与IR关系最为密切。产前TNF-α预测GDM的RCO曲线显示,线下面积为0.912,CI值为0.763~0.936,由此得出TNF-α诊断阈值为6.98μg/L。通过产前CRP预测GDM的ROC曲线显示,线下面积为0.876,CI值为0.584~0.762,由此得出CRP诊断阈值为0.573 mg/L。两者诊断的平均灵敏度为87.6%,平均特异度为79.6%,阳性预测值为87.9%,阴性预测值为74.3%。结论:TNF-α,CRP等相关因子的检测非常重要,其能为GDM的预防和治疗提供坚实的基础。
Objective: To analyze the correlation between tumor necrosis factor α and C reactive protein (CRP), related cytokines and gestational diabetes mellitus (GDM). Methods: Eleven pregnant women were selected during the pregnancy test from the outpatient department of Yanbian University Affiliated Hospital from 2011 to 2013. They were divided into three groups: normal glucose tolerance test (OGTT) group (n = 30), OGTT impaired glucose tolerance group (IGTT group) 40 cases, OGTT diabetes group (GDM group) 40 cases. All testing pregnant women were drawn fasting venous blood 4 ml, centrifuged serum, 3000 r / min, and then stored in a low temperature refrigerator. TNF-α was measured by sandwich enzyme-linked immunosorbent assay (ELISA), CRP was measured by speed nephelometry, adiponectin was measured by ELISA, insulin time was measured by automatic time-resolved analysis, and blood glucose was measured by glucose oxidase. Results: Compared with NGT group, the levels of TNF-α, CRP and HOMA-IR of cytokines in GDM group and IGGT group were significantly higher than those in NGT group. Correlation between cytokine levels and multiple linear regression analysis showed that the level of TNF-α was most closely related to IR. Prenatal TNF-α predicted GCO RCO curve showed that the area under the line was 0.912, CI 0.763 to 0.936, which concluded that the threshold for the diagnosis of TNF-α was 6.98μg / L. The ROC curve of GDM predicted by prenatal CRP showed that the area under the line was 0.876 and the CI value was 0.584 ~ 0.762, thus the diagnostic threshold of CRP was 0.573 mg / L. The average sensitivity of the two diagnosis was 87.6%, the average specificity was 79.6%, the positive predictive value was 87.9%, the negative predictive value was 74.3%. Conclusion: The detection of TNF-α, CRP and other related factors is very important, which can provide a solid foundation for the prevention and treatment of GDM.