血清AT1-AA、sTWEAK对妊娠期糖尿病患者不良妊娠结局的预测价值

doi:10.3969/j.issn.1673-8640.2026.09.003

摘要/Abstract

摘要：

目的探讨血清血管紧张素Ⅱ 1型受体自身抗体（AT1-AA）和可溶性肿瘤坏死因子样凋亡弱诱导剂（sTWEAK）对妊娠期糖尿病（GDM）患者不良妊娠结局的预测价值。方法选取2022年2月—2023年2月石家庄市妇幼保健院GDM患者128例、健康孕妇74例（对照组）。根据GDM患者的妊娠结局分为良好妊娠组（70例）和不良妊娠组（58例）。收集所有研究对象的临床资料，并检测血糖、血脂相关指标和血清AT1-AA、sTWEAK水平。采用Pearson相关分析评估GDM患者血清AT1-AA与sTWEAK的相关性。采用多因素Logistic回归分析评估GDM患者发生不良妊娠的影响因素。采用受试者工作特征（ROC）曲线评估各项指标单项检测和血清AT1-AA、sTWEAK联合检测判断GDM患者不良妊娠的效能。结果与对照组比较，良好妊娠组和不良妊娠组空腹血糖（FPG）、糖化血红蛋白（HbA_1c）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、AT1-AA、sTWEAK均显著升高（P<0.001）。不良妊娠组FPG、HbA_1c、FINS、HOMA-IR、AT1-AA、sTWEAK均显著高于良好妊娠组（P<0.05）。3个组之间年龄、体重指标、孕次、孕周和高密度脂蛋白胆固醇（HDL-C）水平差异均无统计学意义（P>0.05）。GDM患者血清AT1-AA与sTWEAK呈正相关（r=0.465，P<0.05）。FPG、FINS、AT1-AA、sTWEAK、HOMA-IR升高均是GDM患者发生不良妊娠的危险因素（P<0.05）。FPG、FINS、HOMA-IR、AT1-AA、sTWEAK单项检测和AT1-AA、sTWEAK联合检测判断GDM患者不良妊娠的曲线下面积（AUC）分别为0.605、0.714、0.689、0.831、0.834、0.949。结论血清AT1-AA、sTWEAK联合检测对GDM患者不良妊娠有一定的预测价值，或可作为GDM患者预后评估的生物标志物。

关键词: 血管紧张素Ⅱ1型受体自身抗体, 可溶性肿瘤坏死因子样凋亡弱诱导剂, 妊娠期糖尿病, 妊娠结局

Abstract:

Objective To investigate the predictive value of serum angiotensin Ⅱ type 1 receptor autoantibody （AT1-AA） and soluble tumor necrosis factor-like weak inducer of apoptosis（sTWEAK）for adverse pregnancy outcomes in patients with gestational diabetes mellitus（GDM）. Methods A total of 128 GDM patients and 74 healthy pregnant females（control group）were enrolled from Shijiazhuang Maternal and Child Health Hospital from February 2022 to February 2023. The GDM patients were classified into good pregnancy group（70 cases）and adverse pregnancy group（58 cases）according to their pregnancy outcomes. The clinical data were collected，and blood glucose，blood lipid-related indicators and serum AT1-AA and sTWEAK levels were determined. Pearson correlation analysis was used to evaluate the correlation between serum AT1-AA and sTWEAK in GDM patients. Multivariate Logistic regression analysis was used to evaluate the influencing factors of adverse pregnancy in GDM patients. The efficacy of single and combined determinations of serum AT1-AA and sTWEAK in judging adverse pregnancy in GDM patients was evaluated using receiver operating characteristic（ROC）curve. Results Compared with control group，fasting plasma glucose（FPG），glycated hemoglobin A_1c（HbA_1c），fasting insulin（FINS），homeostasis model assessment for insulin resistance（HOMA-IR），total cholesterol（TC），triglyceride（TG），low-density lipoprotein cholesterol（LDL-C），AT1-AA and sTWEAK levels in good pregnancy group and adverse pregnancy group were higher（P<0.001）. The FPG，HbA_1c，FINS，HOMA-IR，AT1-AA and sTWEAK levels in adverse pregnancy group were higher than those in good pregnancy group（P<0.05）. There was no statistical significance in age，body mass index，number of pregnancies，gestational weeks and high-density lipoprotein cholesterol（HDL-C）levels among the 3 groups（P>0.05）. Serum AT1-AA and sTWEAK in GDM patients were positively correlated （r=0.465，P<0.05）. Elevated FPG，FINS，AT1-AA，sTWEAK and HOMA-IR were all risk factors for adverse pregnancy in GDM patients（P<0.05）. The areas under curves（AUC）of single determinations of FPG，FINS，HOMA-IR，AT1-AA，sTWEAK and the combined determination of AT1-AA and sTWEAK for judging adverse pregnancy in GDM patients were 0.605，0.714，0.689，0.831，0.834 and 0.949，respectively. Conclusions The combined determination of serum AT1-AA and sTWEAK has predictive efficacy for adverse pregnancy outcomes in GDM patients，and it may be used as a biomarker for prognosis evaluation of GDM patients.

Key words: Angiotensin Ⅱ type 1 receptor autoantibody, Soluble tumor necrosis factor-like weak inducer of apoptosis, Gestational diabetes mellitus, Pregnancy outcome

中图分类号:

R446.62

张丽梅, 刘华, 张琳, 阎秀云, 郭瑞卿. 血清AT1-AA、sTWEAK对妊娠期糖尿病患者不良妊娠结局的预测价值[J]. 检验医学, 2026, 41(9): 840-845.

ZHANG Limei, LIU Hua, ZHANG Lin, YAN Xiuyun, GUO Ruiqing. Predictive value of serum AT1-AA and sTWEAK for adverse pregnancy outcomes in patients with gestational diabetes mellitus[J]. Laboratory Medicine, 2026, 41(9): 840-845.

图/表 4

参考文献 19

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组别	例数	年龄/岁	体重指标/（kg·m^-2）	孕次/次	孕周/周		FPG/（mmol·L^-1）	HbA_1c/%
对照组	74	28.19±4.35	24.63±3.17	1.23±0.32	30.48±4.37		4.26±1.59	5.43±1.82
良好妊娠组	70	29.37±4.59	24.89±3.28	1.24±0.37	30.51±4.34		6.27±1.85^*	6.47±2.19^*
不良妊娠组	58	28.42±4.46	24.56±3.12	1.27±0.46	30.59±4.40		6.95±2.32^*#	7.21±2.26^*#
F值		1.378	0.197	0.188	0.011		36.469	12.216
P值		0.254	0.821	0.829	0.989		<0.001	<0.001
组别	FINS/（mmol·L^-1）	HOMA-IR	TC/（mmol·L^-1）	TG/（mmol·L^-1）	HDL-C/（mmol·L^-1）	LDL-C/（mmol·L^-1）	AT1-AA/（ng·L^-1）	sTWEAK/（ng·L^-1）
对照组	7.63±1.94	1.78±0.14	4.80±0.63	2.54±0.63	1.75±0.32	3.75±1.02	69.78±12.42	59.23±10.49
良好妊娠组	8.34±2.18^*	2.32±0.18^*	6.43±1.39^*	3.62±1.26^*	1.72±0.29	4.34±1.18^*	116.40±16.44^*	71.84±14.95^*
不良妊娠组	9.52±2.26^*#	2.94±0.23^*#	6.87±1.86^*	3.89±1.47^*	1.67±0.24	4.79±1.51^*	136.39±16.95^*#	89.67±16.41^*#
F值	13.004	652.161	45.134	26.653	1.258	11.854	339.734	77.323
P值	<0.001	<0.001	<0.001	<0.001	0.287	<0.001	<0.001	<0.001

组别	例数	年龄/岁	体重指标/（kg·m^-2）	孕次/次	孕周/周		FPG/（mmol·L^-1）	HbA_1c/%
对照组	74	28.19±4.35	24.63±3.17	1.23±0.32	30.48±4.37		4.26±1.59	5.43±1.82
良好妊娠组	70	29.37±4.59	24.89±3.28	1.24±0.37	30.51±4.34		6.27±1.85^*	6.47±2.19^*
不良妊娠组	58	28.42±4.46	24.56±3.12	1.27±0.46	30.59±4.40		6.95±2.32^*#	7.21±2.26^*#
F值		1.378	0.197	0.188	0.011		36.469	12.216
P值		0.254	0.821	0.829	0.989		<0.001	<0.001
组别	FINS/（mmol·L^-1）	HOMA-IR	TC/（mmol·L^-1）	TG/（mmol·L^-1）	HDL-C/（mmol·L^-1）	LDL-C/（mmol·L^-1）	AT1-AA/（ng·L^-1）	sTWEAK/（ng·L^-1）
对照组	7.63±1.94	1.78±0.14	4.80±0.63	2.54±0.63	1.75±0.32	3.75±1.02	69.78±12.42	59.23±10.49
良好妊娠组	8.34±2.18^*	2.32±0.18^*	6.43±1.39^*	3.62±1.26^*	1.72±0.29	4.34±1.18^*	116.40±16.44^*	71.84±14.95^*
不良妊娠组	9.52±2.26^*#	2.94±0.23^*#	6.87±1.86^*	3.89±1.47^*	1.67±0.24	4.79±1.51^*	136.39±16.95^*#	89.67±16.41^*#
F值	13.004	652.161	45.134	26.653	1.258	11.854	339.734	77.323
P值	<0.001	<0.001	<0.001	<0.001	0.287	<0.001	<0.001	<0.001

因素	β值	标准误	Wald值	P值	OR^①值（95%CI^②）
FPG	0.545	0.236	5.337	0.021	1.725（1.086~2.740）
FINS	0.496	0.182	7.425	0.006	1.642（1.149~2.346）
HOMA-IR	0.538	0.219	6.041	0.014	1.713（1.115~2.631）
AT1-AA	0.510	0.205	6.185	0.013	1.665（1.114~2.488）
sTWEAK	0.514	0.198	6.740	0.009	1.672（1.134~2.465）

因素	β值	标准误	Wald值	P值	OR^①值（95%CI^②）
FPG	0.545	0.236	5.337	0.021	1.725（1.086~2.740）
FINS	0.496	0.182	7.425	0.006	1.642（1.149~2.346）
HOMA-IR	0.538	0.219	6.041	0.014	1.713（1.115~2.631）
AT1-AA	0.510	0.205	6.185	0.013	1.665（1.114~2.488）
sTWEAK	0.514	0.198	6.740	0.009	1.672（1.134~2.465）

项目	AUC（95%CI）	最佳临界值	敏感性/%	特异性/%	Youden指数
FPG	0.605（0.515~0.690）	6.53 mmol·L^-1	58.62	60.00	0.186
FINS	0.714（0.627~0.790）	8.95 mmol·L^-1	68.97	68.57	0.375
HOMA-IR	0.689（0.601~0.768）	2.53	74.14	75.71	0.499
AT1-AA	0.831（0.754~0.891）	123.27 ng·L^-1	79.31	85.71	0.650
sTWEAK	0.834（0.758~0.894）	84.01 pg·mL^-1	72.41	87.14	0.596
AT1-AA+sTWEAK	0.949（0.895~0.980）	0.53	86.21	91.43	0.776