妊娠糖尿病孕妇妊娠中期血清铜及部分代谢指标的变化
Maternal Serum Copper and Some Metabolic Indexes in Late Second Trimester of Gestational Diabetes Mellitus Pregnancy.
出版信息
Clin Lab. 2024 Jan 1;70(1). doi: 10.7754/Clin.Lab.2023.230624.
BACKGROUND
Copper (Cu) is a physiologically important trace element during pregnancy. The study aim is to assess the altered level of serum Cu and its association with some metabolic indexes in Gestational Diabetes Mellitus (GDM).
METHODS
A total of 108 pregnant women (aged 18 - 40, second trimester) are included in the study and divided into two groups (GDM n = 54; pregnant with normal glucose tolerance (NGT), n = 54) after performing a 2-hour 75-g oral glucose tolerance test (OGTT). Maternal blood samples are collected at 26 - 28 gestational week. All biochemical parameters are measured in serum from fasting venous blood. Serum Cu levels are analyzed by flame atomic absorption spectrophotometry (Perkin Elmer AAnalyst 300, USA). Body Mass Index (BMI), insulin sensitivity/resistance, triglyceride-glucose (TyG), TyG-BMI (triglyceride glucose-body mass) indexes are calculated by formulas.
RESULTS
The following data were observed: significantly higher levels of serum Cu (p = 0.009), pre-pregnancy BMI (pre-pBMI), BMI at the GDM diagnosis (pBMI), TyG, pregnancy TyG-BMI (pTyG-BMI) p < 0.001, and triglycerides (Tgl) (p = 0.02) in GDM compared to NGT pregnancy. The study presents a positive correlation between serum Cu and pre-pBMI (p < 0.02), pBMI and pTyG-BMI (p < 0.001). Besides, pre-pBMI (mean ≥ 25 kg/m2), pBMI (mean ≥ 30 kg/m2), and pTyG-BMI are associated with 14.5% (OR 1.145, 95% CI: 1.064 - 1.232; p < 0.001), 15.3% (OR 1.153, 95% CI: 1.070 - 1.243; p < 0.001), and 5.9% (OR 1.059, 95% CI: 1.022 - 1.086; p < 0.001) increased risk for GDM development. No association is found between Cu and Tgl levels, fasting plasma glucose e(FPG) and TyG. ROC analysis suggests the serum Cu as a possible risk factor for GDM development. The analysis shows that at a cutoff point of ≥ 31.9 µmol/L, serum Cu presents a sensitivity and specificity of 64.8% and 66.7% in the prediction of GDM development (AUC = 0.659, p < 0.012). After adjustment for maternal age, gestational age, and family predisposition, the odds ratios (ORs) (95% CIs) still show association of Cu levels with increased GDM risk (OR 1.099, 95% CI 1.018 - 1.184, p = 0.013).
CONCLUSIONS
pTyG-BMI index exhibits a better interaction than TyG index, Tgl, and glucose separately with serum Cu levels where BMI has a mediator's role.
背景
铜（Cu）是妊娠期间一种重要的生理微量元素。本研究旨在评估妊娠期糖尿病（GDM）患者血清 Cu 水平的变化及其与某些代谢指标的关系。
方法
共纳入 108 名孕妇（年龄 18-40 岁，孕中期），在进行 2 小时 75g 口服葡萄糖耐量试验（OGTT）后分为两组（GDM 组 n=54；糖耐量正常的孕妇（NGT）组 n=54）。在妊娠 26-28 周时采集孕妇静脉血样。所有生化参数均在空腹静脉血血清中检测。采用火焰原子吸收分光光度法（美国珀金埃尔默公司的 Analysist 300）分析血清 Cu 水平。通过公式计算体重指数（BMI）、胰岛素敏感性/抵抗性、甘油三酯-葡萄糖（TyG）、TyG-BMI（甘油三酯葡萄糖-体重指数）指数。
结果
与 NGT 妊娠相比，GDM 组的血清 Cu 水平（p=0.009）、孕前 BMI（pre-pBMI）、GDM 诊断时的 BMI（pBMI）、TyG、妊娠 TyG-BMI（pTyG-BMI）均显著升高（p<0.001），且甘油三酯（Tgl）水平也升高（p=0.02）。研究表明血清 Cu 与 pre-pBMI 呈正相关（p<0.02），pBMI 与 pTyG-BMI 呈正相关（p<0.001）。此外，pre-pBMI（均值≥25kg/m2）、pBMI（均值≥30kg/m2）和 pTyG-BMI 与 14.5%（OR 1.145，95%CI：1.064-1.232；p<0.001）、15.3%（OR 1.153，95%CI：1.070-1.243；p<0.001）和 5.9%（OR 1.059，95%CI：1.022-1.086；p<0.001）的 GDM 发病风险增加相关。血清 Cu 水平与 Tgl、空腹血糖（FPG）和 TyG 均无相关性。ROC 分析表明血清 Cu 可能是 GDM 发病的危险因素。分析显示，当血清 Cu 水平的截断值为≥31.9µmol/L 时，血清 Cu 对 GDM 发病的预测具有 64.8%的敏感性和 66.7%的特异性（AUC=0.659，p<0.012）。在校正了母亲年龄、孕龄和家族易感性后，Cu 水平与 GDM 风险增加的比值比（OR）（95%CI）仍呈正相关（OR 1.099，95%CI 1.018-1.184，p=0.013）。
结论
pTyG-BMI 指数与血清 Cu 水平的相互作用优于 TyG 指数、Tgl 和血糖，且 BMI 在此过程中起中介作用。
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