上海交通大学学报（医学版）

上海交通大学学报（医学版） >

2022 , Vol. 42 >Issue 7: 898 - 903

DOI: https://doi.org/10.3969/j.issn.1674-8115.2022.07.008

论著 · 临床研究

孕早期成纤维生长因子19亚族对妊娠期糖尿病的预测价值

  • 高菲 ,
  • 卢宇 ,
  • 董书琴 ,
  • 杨柳 ,
  • 吴邵花 ,
  • 韦静
展开
  • 1.大连医科大学研究生院，大连 116000
    2.江苏省泰州市人民医院内分泌科，泰州 225300
    3.江苏省泰州市人民医院产科，泰州 225300
高　菲（1995—），女，硕士生；电子信箱：2827344131@qq.com。
卢　宇，电子信箱：luyu_666@126.com。

收稿日期: 2022-05-04

  录用日期: 2022-06-27

  网络出版日期: 2022-09-04

基金资助

江苏省“六大人才高峰”高层次人才项目(WSN-336);江苏省“六个一工程”拔尖人才项目(LGY2020067);泰州市科技支撑计划（社会发展）项目(TS201902)

收起

Predictive value of fibroblast growth factor 19 subgroup in early pregnancy on gestational diabetes mellitus

  • Fei GAO ,
  • Yu LU ,
  • Shuqin DONG ,
  • Liu YANG ,
  • Shaohua WU ,
  • Jing WEI
Expand
  • 1.Graduate School, Dalian Medical University, Dalian 116000, China
    2.Department of Endocrinology, Taizhou People's Hospital, Jiangsu Province, Taizhou 225300, China
    3.Department of Obstetrics, Taizhou People's Hospital, Jiangsu Province, Taizhou 225300, China
LU Yu, E-mail: luyu_666@126.com.

Received date: 2022-05-04

  Accepted date: 2022-06-27

  Online published: 2022-09-04

Supported by

Jiangsu Province High Level Talent Project(WSN-336);Jiangsu Province Top Talent Project(LGY2020067);Taizhou Science and Technology Support Plan Project(TS201902)

Fold

摘要

目的·探讨孕早期血清成纤维生长因子（fibroblast growth factor，FGF）19亚族（包括FGF19、21、23）与妊娠期糖尿病（gestational diabetes mellitus，GDM）发生风险的关系。方法·收集2019年10月—2020年10月在江苏省泰州市人民医院产科进行产检的孕早期（8~12周）妇女的空腹血糖（fasting plasma glucose，FPG）、血脂、FGF19、FGF21、FGF23等水平资料，依据孕24~28周75 g口服葡萄糖耐量试验结果分为GDM组和糖耐量正常（normal glucose tolerance，NGT）组。比较2组FGF19、FGF21、FGF23的水平，分析其与GDM的关系。结果·共完成180例孕妇的随访，其中GDM组27例，NGT组153例。与NGT组相比，GDM组FGF21和FPG水平明显升高，而FGF19及FGF23水平明显降低（均P<0.05）。相关性分析发现，FPG与FGF19呈负相关（r=-0.283，P<0.01），与LogFGF21呈正相关（r=0.160，P<0.05），与LogFGF23无明显相关性（P>0.05）。单因素回归分析表明，FGF19、FGF21、FGF23和FPG均是GDM的影响因素（均P<0.05）。进一步行多因素Logistic回归分析，结果显示FGF21和FPG仍是GDM的危险因素（OR=1.196，P=0.000；OR=2.280，P=0.010）。FGF21、FPG及二者联合检测GDM的ROC曲线下面积依次为0.707、0.646、0.847。结论·孕早期时GDM孕妇已经出现FGF21和FPG水平升高，FGF19和FGF23水平下降；且孕早期FGF21和FPG是GDM的危险因素，二者联合预测GDM具有较大的诊断效能。

关键词： 血清成纤维生长因子19; 血清成纤维生长因子21; 血清成纤维生长因子23; 血糖; 妊娠期糖尿病; 孕早期

本文引用格式

高菲 , 卢宇 , 董书琴 , 杨柳 , 吴邵花 , 韦静 . 孕早期成纤维生长因子19亚族对妊娠期糖尿病的预测价值[J]. 上海交通大学学报（医学版）, 2022 , 42(7) : 898 -903 . DOI: 10.3969/j.issn.1674-8115.2022.07.008

Abstract

Objective

·To investigate the relationship between serum levels of fibroblast growth factor 19 subgroup (FGF19, 21 and 23) and the risk of gestational diabetes mellitus (GDM) in early pregnancy.

Methods

·The levels of fasting blood glucose (FPG), blood lipid, FGF19, FGF21 and FGF23 of women in the early pregnancy (8-12 weeks) who underwent obstetric examination in Taizhou People's Hospital from October 2019 to October 2020 were collected. According to the results of 75 g oral glucose tolerance test at 24-28 weeks of pregnancy, they were divided into GDM group and NGT group. The levels of FGF19, FGF21 and FGF23 were compared between the two groups, and their relationship with GDM were analyzed.

Results

·A total of 180 pregnant women were followed up, including 27 cases in the GDM group and 153 cases in the NGT group. Compared with the NGT group, FGF21 levels in the GDM group were significantly higher, while the levels of FGF19 and FGF23 were significantly lower (P<0.05, respectively). Correlation analysis showed that FPG was negatively correlated with FGF19 (r=-0.283, P<0.01), and positively correlated with LogFGF21 (r=0.160, P<0.05), and had no significant correlation with LogFGF23 (P>0.05). Single factor regression analysis showed that FGF19, FGF21, FGF23 and FPG were influencing factors of GDM (P<0.05, respectively). Multivariate Logistic regression analysis showed that FGF21 and FPG were risk factors for GDM (OR=1.196, P=0.000; OR=2.280, P=0.010). The areas under the ROC curve of FGF21, FPG and their combined prediction of GDM were 0.707, 0.646 and 0.847.

Conclusion

·The levels of FGF21 and FPG increase, while the levels of FGF19 and FGF23 decrease in GDM pregnancies in early pregnancy. FGF21 and FPG are risk factors of GDM. The FGF21- and FPG- combined prediction of GDM has greater diagnostic efficiency.

Key words： fibroblast growth factor 19; fibroblast growth factor 21; fibroblast growth factor 23; blood glucose; gestational diabetes mellitus; early pregnancy

参考文献

1 GAO C, SUN X, LU L, et al. Prevalence of gestational diabetes mellitus in mainland China: a systematic review and meta-analysis [J]. Diabet Investig, 2019, 10(1):154-162.
2 JOHNS E C, DENISON F C, NORMAN J E, et al. Gestational diabetes mellitus: mechanisms, treatment, and complications[J]. Trends Endocrinol Metab, 2018, 29(11): 743-754.
3 DEGIROLAMO C, SABBà C, MOSCHETTA A. Therapeutic potential of the endocrine fibroblast growth factors FGF19, FGF21 and FGF23[J]. Nat Rev Drug Discov, 2016, 15(1): 51-69.
4 赵月婷, 徐一娇, 徐书杭, 等. 成纤维细胞生长因子19亚家族因子在相关代谢性疾病中的临床研究进展[J]. 医学综述, 2018, 24(1): 51-56.
4 ZHAO Y T, XU Y J, XU S H, et al. Clinical research progress of fibroblast growth factor 19 subfamily in metabolic diseases[J]. Med Recapitul, 2018, 24(1): 51-56.
5 中华医学会妇产科学分会产科学组, 中华医学会围产医学分会妊娠合并糖尿病协作组. 妊娠合并糖尿病诊治指南(2014)[J]. 中华妇产科杂志, 2014, 49(8): 561-569.
5 Obstetrics Group, Obstetrics and Gynecology Branch of Chinese Medical Association,Pregnancy with Diabetes Collaborative Group, Perinatal Medicine Branch of Chinese Medical Association. Guidelines for the diagnosis and treatment of diabetes mellitus in pregnancy (2014)[J]. Chin J Obstetr Gynecol, 2014, 49(8): 561-569.
6 FEGHALI M N, SCIFRES C M. Novel therapies for diabetes mellitus in pregnancy[J]. BMJ Clin Res Ed, 2018, 362: k2034.
7 LIU B, CAI J, XU Y, et al. Early diagnosed gestational diabetes mellitus is associated with adverse pregnancy outcomes: a prospective cohort study[J]. J Clin Endocrinol Metab, 2020, 105(12): e4264-e4274.
8 XIE T, SO W Y, LI X Y, et al. Fibroblast growth factor 21 protects against lipotoxicity-induced pancreatic β?cell dysfunction via regulation of AMPK signaling and lipid metabolism[J]. Clin Sci, 2019, 133(19): 2029-2044.
9 WATANABE H, MIYAHISA M, CHIKAMATSU M, et al. Development of a long acting FGF21 analogue-albumin fusion protein and its anti-diabetic effects[J]. J Control Release, 2020, 324: 522-531.
10 葛李娜, 杨进, 洪天配. 成纤维细胞生长因子21在血糖调节中的作用及其治疗学意义[J]. 中华糖尿病杂志, 2018, 10(6): 434-437.
10 GE L N, YANG J, HONG T P. The role of fibroblast growth factor 21 in blood glucose regulation and its therapeutic significance[J]. Chin J Diabet Mellit, 2018, 10(6): 434-437.
11 吴佳铭. 白色脂肪中FGF21抵抗对妊娠期糖尿病发病的功能及分子机制研究[D]. 广州: 广东药科大学, 2019.
11 WU J M. Fibroblast growth factor 21 (FGF21) resistance in adipose tissue is associated with the pathogenesis of gestational diabetes mellitus in humans[D]. Guangzhou: Guangdong Pharmaceutical University, 2019.
12 BONAKDARAN S, KHORASANI Z M, JAFARZADEH F. Increased serum level of fgf21 in gestational diabetes mellitus[J]. Acta Endocrinol (Buchar), 2017, 13(3): 278-281.
13 WANG Z H, YUAN M, XU C J, et al. FGF21 serum levels in the early second trimester are positively correlated with the risk of subsequent gestational diabetes mellitus: a propensity-matched nested case-control study[J]. Front Endocrinol, 2021, 12: 630287.
14 GADALETA R M, MOSCHETTA A. Metabolic messengers: fibroblast growth factor 15/19[J]. Nat Metab, 2019, 1(6): 588-594.
15 TANG M J, SU J B, XU T L, et al. Serum fibroblast growth factor 19 and endogenous islet beta cell function in type 2 diabetic patients [J]. Diabetol Metab Syndr, 2019, 11: 79.
16 WANG D Y, XU S Q, DING W J, et al. Decreased placental and muscular expression of the fibroblast growth factor 19 in gestational diabetes mellitus[J]. J Diabet Investig, 2019, 10(1): 171-181.
17 ZHOU M, LEARNED R M, ROSSI S J, et al. Engineered FGF19 eliminates bile acid toxicity and lipotoxicity leading to resolution of steatohepatitis and fibrosis in mice[J]. Hepatol Commun, 2017, 1(10): 1024-1042.
18 WANG D, ZHU W, LI J, et al. Serum concentrations of fibroblast growth factors 19 and 21 in women with gestational diabetes mellitus: association with insulin resistance, adiponectin, and polycystic ovary syndrome history[J]. PLoS One, 2013, 8(11): e81190.
19 URSEM S R, VERVLOET M G, BüTTLER R M, et al. The interrelation between FGF23 and glucose metabolism in humans[J]. J Diabetes Complicat, 2018, 32(9): 845-850.
20 B?R L, FEGER M, FAJOL A, et al. Insulin suppresses the production of fibroblast growth factor 23 (FGF23)[J]. PNAS, 2018, 115(22): 5804-5809.
21 MOSAVAT M, OMAR S Z, STHANSHEWAR P. Serum FGF-21 and FGF-23 in association with gestational diabetes: a longitudinal case-control study[J]. Horm Mol Biol Clin Investig, 2020, 41(2). DOI:1515/hmbci-2019-0060.
Options
文章导航

/

〈 〉