2026 年第 7 期 第 21 卷

妊娠期糖尿病患者孕中晚期血清趋化素水平变化轨迹对妊娠结局的预测价值

Predictive value of serum chemerin level trajectory in the second and third trimesters for pregnancy outcomes in patients with gestational diabetes mellitus

作者：谷袁源黄尹薇杨拉

英文作者：Gu Yuanyuan Huang Yinwei Yang La

单位：

英文单位：Department of Obstetrics and Gynecology the Affiliated Hospital of Guizhou Medical University Guiyang 550001 China

关键词：妊娠期糖尿病；趋化素；变化轨迹；妊娠结局；相关性；预测

英文关键词：Gestationaldiabetesmellitus;Chemerin;Trajectory;Pregnancyoutcome;Correlation;Prediction

• 摘要：

• 目的 分析妊娠期糖尿病（GDM）患者孕中晚期血清趋化素水平变化轨迹预测妊娠结局的价值。方法 选取2023年1月至2024年7月贵州医科大学附属医院收治的210例GDM患者作为GDM组，105例健康孕妇作为对照组，比较2组孕24周、32周、分娩前血清趋化素水平。GDM组通过潜类别轨迹模型(LCTM)筛选出血清趋化素水平不同变化轨迹组，GDM组随访至妊娠结束统计不良妊娠结局发生情况。对比GDM患者不同变化轨迹组血清趋化素水平、一般资料、不良妊娠结局发生率，通过Logistic回归分析血清趋化素水平变化轨迹与GDM患者不良妊娠结局的相关性，应用受试者工作特征(ROC)曲线分析血清趋化素水平变化轨迹预测GDM患者不良妊娠结局的价值。结果 对照组孕24周、32周、分娩前血清趋化素水平无明显变化（P＞0.05）；GDM患者孕24周、32周、分娩前血清趋化素水平逐渐降低（P＜0.001），且GDM组孕24周、32周、分娩前血清趋化素水平均高于对照组孕24周、32周、分娩前血清趋化素水平（均P＜0.001）。LCTM筛选结果最终确定3个分类轨迹最优，据此将GDM组分为3个变化轨迹组：T1组（孕中晚期血清趋化素从低水平降至较低水平，65例）、T2组（孕中晚期血清趋化素从中高水平降至低水平，92例）、T3组（孕中晚期血清趋化素始终保持在高水平，53例）。GDM患者不良妊娠结局发生率为24.8%（52/210）。T3组孕前体重指数、75 g口服葡萄糖耐量试验2 h血糖（OGTT 2 h）、糖化血红蛋白（HbA1c）、稳态模型胰岛素抵抗指数、不良妊娠结局发生率及孕24周、32周、分娩前血清趋化素水平均高于T2组、T1组，T2组高于T1组（均P＜0.05）；OGTT 2 h、HbA1c、血清趋化素水平变化轨迹均为GDM患者不良妊娠结局的独立危险因素（均P＜0.05），将OGTT 2 h、HbA1c校正后分析显示，血清趋化素水平变化轨迹仍为GDM患者不良妊娠结局的独立危险因素（P＜0.05）；血清趋化素水平呈高-高变化轨迹预测GDM患者不良妊娠结局的曲线下面积为0.852，预测敏感度、特异度分别为80.77%、84.81%，约登指数为0.656。结论 GDM患者孕中晚期血清趋化素水平变化轨迹与妊娠结局存在显著相关性，血清趋化素水平呈高-高变化轨迹在预测不良妊娠结局风险中具有较高预测效能。

• Objective To analyze the predictive value of serum chemerin level trajectory in the second and third trimesters for pregnancy outcomes in patients with gestational diabetes mellitus (GDM). Methods A total of 210 GDM patients admitted to the Affiliated Hospital of Guizhou Medical University from January 2023 to July 2024 were enrolled as the GDM group, and 105 healthy pregnant women as the control group. Serum chemerin levels at 24 weeks, 32 weeks of gestation and before delivery were compared between the two groups. Latent class trajectory modeling (LCTM) was used to identify subgroups with different serum chemerin trajectories in the GDM group. All GDM patients were followed up until delivery to record adverse pregnancy outcomes. Serum chemerin levels, baseline characteristics and incidence of adverse pregnancy outcomes were compared among different trajectory subgroups. Logistic regression was used to analyze the correlation between chemerin trajectory and adverse pregnancy outcomes. Receiver operating characteristic (ROC) curve was applied to evaluate the predictive value of chemerin trajectory for adverse pregnancy outcomes. Results Serum chemerin levels showed no significant change at 24 weeks, 32 weeks and before delivery in the control group (P>0.05), but decreased gradually in the GDM group (P<0.001). Serum chemerin levels in the GDM group were significantly higher than those in the control group at all three time points (all P<0.001). LCTM identified three optimal trajectory subgroups: T1 (low to relatively low chemerin level, n=65), T2 (moderately high to low level, n=92), and T3 (persistently high level, n=53). The overall incidence of adverse pregnancy outcomes in the GDM group was 24.8% (52/210). Pre-pregnancy body mass index, 2 h 75 g oral glucose tolerance test (OGTT) blood glucose, glycated hemoglobin (HbA1c), homeostasis model assessment of insulin resistance, serum chemerin levels at all time points and adverse pregnancy outcome rate were highest in T3, followed by T2 and then T1 (all P<0.05). OGTT 2 h glucose, HbA1c and chemerin trajectory were independent risk factors for adverse pregnancy outcomes (all P<0.05). After adjustment for OGTT 2 h glucose and HbA1c, chemerin trajectory remained an independent risk factor (P<0.05). The area under the curve of persistently high chemerin trajectory for predicting adverse pregnancy outcomes was 0.852, with a sensitivity of 80.77%, specificity of 84.81% and Youden index of 0.656. Conclusions Serum chemerin trajectory in the second and third trimesters is significantly correlated with pregnancy outcomes in GDM patients. A persistently high chemerin level trajectory has high predictive efficacy for adverse pregnancy outcomes.