Predictive value of serum AT1-AA and sTWEAK for adverse pregnancy outcomes in patients with gestational diabetes mellitus

doi:10.3969/j.issn.1673-8640.2026.09.003

Abstract

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

CLC Number:

R446.62

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.

Figures/Tables 4

References 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