To explore the application value of serum Gal-13, GLP-1 and VEGF in the prevention and guidance of adverse pregnancy outcomes in gestational diabetes (GDM). A retrospective study with case-control method was used to select 1 012 GDM patients from Haikou Maternal and Child Health Hospital from January 2019 to December 2022 as the study objects, and they were divided into poor pregnancy outcome group (n=342) and good pregnancy outcome group (n=670) according to whether they had adverse pregnancy outcomes. The medical records of 521 healthy women with normal glucose metabolism were selected as the control group. Serum Gal-13 and GLP-1 were detected by enzyme-linked immunosorbent assay and VEGF was determined by IAMMGE specific protein analyzer. After comparing the differences of the above factors among the three groups, multivariate logistic regression model was used to analyze the influencing factors of adverse pregnancy outcomes in GDM patients, and ROC curve was drawn to analyze the predictive value of serum Gal-13, GLP-1 and VEGF levels on adverse pregnancy outcomes in GDM patients. The results showed that Fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c) and fasting insulin (FINS) in the adverse pregnancy outcome group were 5.92(4.98, 6.41) mmol/L, 5.32(4.96, 5.47)%, 62.56(49.21,99.50) pmol/L, VEGF was 495.47(389.14, 567.13) ng/L, TSH was 1.48(1.34, 1.58) mIU/L, right ventricular myocardial work index (Tei index) was 0.59(0.45, 0.67), 89 cases of elderly parturients; FPG was 4.45(4.16, 5.03) mmol/L, HbA1c was 5.04(4.86, 5.29)%, FINS was 57.41(46.90, 74.08) pmol/L, VEGF was 405.84(348.02, 462.68) ng/L, TSH was 1.42(1.25, 1.50) mIU/L, Tei index was 0.50(0.47, 0.64), there were 142 cases of old women. In the control group, FPG was 4.33(4.05, 4.75) mmol/L, HbA1c was 5.01(4.13, 5.18)%, FINS was 38.48(36.76, 41.72) pmol/L and VEGF was 302.45(283.14, 336.56) ng/L, TSH was 1.32(1.24, 1.47)mIU/L, Tei index was 0.48(0.39, 0.59), and there were 106 elderly parturiencies. The levels of FPG, HbA1c, FINS, VEGF, TSH and Tei index in the adverse pregnancy outcome group and the good pregnancy outcome group were higher than those in the control group, and the proportion of elderly parturients was higher than that in the control group, and the adverse pregnancy outcome group was higher than that in the good pregnancy outcome group. The differences were statistically significant (H=8.620, P<0.001, H=2.616, P=0.014, H=6.156, P<0.001, H=3.051, P<0.001, H=4.892, P=0.044, χ2=2.548, P=0.045). In the adverse pregnancy outcome group, Gal-13 was 15.27(8.35, 24.45)pg/ml, GLP-1 was 9.27(8.26, 12.35) pmol/L and FT4 was 11.59(9.67, 13.48) pmol/L. In the group with good pregnancy outcome, Gal-13 was 25.34(20.14, 29.73) pg/ml, GLP-1 was 12.38(10.25, 15.63) pmol/L and FT4 was 13.86(10.67, 15.10) pmol/L. In the control group, Gal-13 was 31.21(27.48, 34.45) pg/ml, GLP-1 was 11.34(10.40, 14.37) pmol/L and FT4 was 14.15(10.75, 15.43)pmol/L. The levels of Gal-13, GLP-1 and FT4 in the adverse pregnancy outcome group and the good pregnancy outcome group were significantly lower than those in the control group, and the adverse pregnancy outcome group was lower than that in the good pregnancy outcome group. The differences were statistically significant (H=6.458, P=0.011, H=8.445, P<0.001, H=5.694, P<0.001). The levels of Gal-13 and GLP-1 in normal blood glucose recovery group were higher than those in non-normal blood glucose recovery group, and the levels of VEGF were lower than those in non-normal blood glucose recovery group (P<0.05).In multivariate logistic regression analysis, Gal-13, GLP-1, VEGF, TSH, FT4 and Tei indexes were independent influencing factors for adverse pregnancy outcomes with GDM (P<0.05). ROC curve analysis showed that the AUC of Gal-13, GLP-1 and VEGF alone in predicting adverse pregnancy were 0.779, 0.761 and 0.615, respectively. The value of the combined diagnosis was the highest (AUC=0.912), the sensitivity was 90.1%, and the specificity was 80.0%. In conclusion, Gal-13, GLP-1 and VEGF may be independent influencing factors for adverse pregnancy outcomes in GDM patients, and the combined detection of the three may help to improve the auxiliary diagnostic efficacy for predicting adverse pregnancy outcomes.
探讨血清半乳糖凝集素-13（Gal-13）、胰高糖素样肽-1（GLP-1）联合血管内皮生长因子（VEGF）在妊娠期糖尿病（GDM）不良妊娠结局预防指导中的应用价值。采用病例对照回顾性研究方法，选取2019年1月至2022年12月海口市妇幼保健院1 012例GDM患者作为研究对象，根据患者是否发生不良妊娠结局分为妊娠结局不良组（n=342）与妊娠结局良好组（n=670）。另选择521 名糖代谢正常的健康产妇的病历资料作为对照组。采用酶联免疫吸附试验检测血清Gal-13、GLP-1，特定蛋白分析仪测定VEGF。对比3组上述因子水平间的差异，应用多因素logistic回归模型分析GDM患者发生不良妊娠结局的影响因素，并绘制ROC曲线分析血清Gal-13、GLP-1、VEGF水平对GDM不良妊娠结局的预测价值。结果显示，妊娠结局不良组空腹血糖（FPG）为5.92（4.98，6.41）mmol/L、糖化血红蛋白（HbA1c）为5.32（4.96，5.47）%、空腹胰岛素（FINS）为62.56（49.21，99.50）pmol/L、VEGF为495.47（389.14，567.13）ng/L、促甲状腺激素（TSH）为1.48（1.34，1.58）mIU/L、右心室心肌做功指数（Tei指数）为0.59（0.45，0.67）、高龄产妇有89例；妊娠结局良好组FPG为4.45（4.16，5.03）mmol/L、HbA1c为5.04（4.86，5.29）%、FINS为57.41（46.90，74.08）pmol/L、VEGF为405.84（348.02，462.68）ng/L、TSH为1.42（1.25，1.50）mIU/L、Tei指数为0.50（0.47，0.64）、高龄产妇有142例；对照组FPG为4.33（4.05，4.75）mmol/L、HbA1c为5.01（4.13，5.18）%、FINS为38.48（36.76，41.72）pmol/L、VEGF为302.45（283.14，336.56）ng/L、TSH为1.32（1.24，1.47）mIU/L、Tei指数为0.48（0.39，0.59）、高龄产妇有106例。妊娠结局不良组与妊娠结局良好组FPG、HbA1c、FINS、VEGF、TSH、Tei指数水平均高于对照组，高龄产妇占比多于对照组，且妊娠结局不良组高于妊娠结局良好组，差异均有统计学意义（H=8.620，P<0.001，H=2.616，P=0.014，H=6.156，P<0.001，H=3.051，P<0.001，H=4.892，P=0.044，χ2=2.548，P=0.045）。妊娠结局不良组Gal-13为15.27（8.35，24.45）pg/ml、GLP-1为9.27（8.26，12.35）pmol/L、FT4为11.59（9.67，13.48）pmol/L；妊娠结局良好组Gal-13为25.34（20.14，29.73）pg/ml、GLP-1为12.38（10.25，15.63）pmol/L、FT4为13.86（10.67，15.10）pmol/L；对照组Gal-13为31.21（27.48，34.45）pg/ml、GLP-1为11.34（10.40，14.37）pmol/L、FT4为14.15（10.75，15.43）pmol/L。妊娠结局不良组与妊娠结局良好组Gal-13、GLP-1、FT4水平显著低于对照组，且妊娠结局不良组低于妊娠结局良好组，差异均有统计学意义（H=6.458，P=0.011，H=8.445，P<0.001，H=5.694，P<0.001）。血糖恢复正常组Gal-13、GLP-1水平高于血糖未恢复正常组，VEGF水平低于血糖未恢复正常组（P<0.05）。多因素logistic回归分析中Gal-13、GLP-1、VEGF、TSH、FT4、Tei指数为GDM不良妊娠结局发生的独立影响因素（P<0.05）；经ROC曲线分析，Gal-13、GLP-1、VEGF单独预测不良妊娠的 AUC 分别为0.779、0.761、0.615；三项联合诊断价值最大（AUC=0.912），敏感度为90.1%，特异度为80.0%。综上，Gal-13、GLP-1、VEGF 可能是GDM患者不良妊娠结局发生的独立影响因素，三者联合检测可能有助于提高预测不良妊娠结局的辅助诊断效能。.