| 摘要: |
| ［摘要］ 目的 分析浙江大学（ZJU）指数、泛免疫炎症值（PIV）与妊娠期糖尿病（GDM）孕妇胰岛素抵抗（IR）及新生儿结局的关系。方法 回顾性收集2023年1月至2025年2月于西安交通大学第一附属医院榆林医院进行产检和分娩的188例GDM孕妇的临床资料。另根据年龄、孕前体质量指数（BMI）和孕周进行1∶1比例匹配，收集同期经口服葡萄糖耐量试验确定糖耐量正常的188例孕妇（对照组）的临床资料。比较两组ZJU指数、PIV和稳态模型（HOMA）-IR。采用Spearman秩相关分析GDM孕妇ZJU指数、PIV与HOMA-IR的相关性。根据新生儿结局将GDM孕妇分为结局不良组（51例）和结局良好组（137例），采用多因素logistic回归分析影响GDM孕妇新生儿结局的因素。采用受试者工作特征（ROC）曲线分析ZJU指数、PIV预测GDM孕妇新生儿结局不良的效能。结果 GDM组ZJU指数、PIV和HOMA-IR水平显著高于对照组（P<0.05）。Spearman秩相关分析结果显示，GDM孕妇ZJU指数（rs=0.694，P<0.001）、PIV（rs=0.617，P<0.001）与HOMA-IR呈正相关。多因素logistic回归分析结果显示，较高的HOMA-IR［OR（95%CI）=1.407（1.203～1.646）］、ZJU指数［OR（95%CI）=1.356（1.203～1.528）］、PIV［OR（95%CI）=1.107（1.064～1.153）］水平是GDM孕妇发生新生儿结局不良的独立危险因素（P<0.05）。ZJU指数、PIV能有效预测GDM孕妇新生儿结局不良（P<0.05），且两指标联合的预测效能优于单一指标（Z两指标联合-ZJU指数=3.758，P<0.001；Z两指标联合-PIV=3.418，P=0.001），灵敏度为78.43%，特异度为81.02%。结论 ZJU指数、PIV升高与GDM孕妇IR加重及新生儿结局不良相关，两指标联合有助于临床对GDM孕妇进行风险分层管理，改善母婴预后。 |
| 关键词: 妊娠期糖尿病 浙江大学指数 泛免疫炎症值 胰岛素抵抗 新生儿结局 |
| DOI：10.3969/j.issn.1674-3806.2026.09.11 |
| 分类号:R 714 |
| 基金项目:陕西省科学技术研究发展计划项目（编号：2022SF-729） |
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| Analysis of associations of ZJU index and pan-immune-inflammation value with insulin resistance and neonatal outcomes in pregnant women with gestational diabetes mellitus |
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Xue Jiaojie, Zhao Qing, Li Ni
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Department of Obstetrics, Yulin Hospital, the First Affiliated Hospital of Xi′an Jiaotong University, Yulin 719000, China
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| Abstract: |
| ［Abstract］ Objective To analyze the associations of Zhejiang University(ZJU) index and pan-immune-inflammation value(PIV) with insulin resistance(IR) and neonatal outcomes in pregnant women with gestational diabetes mellitus(GDM). Methods The clinical data were retrospectively collected from 188 pregnant women with GDM(GDM group) who underwent prenatal care and delivery in Yulin Hospital, the First Affiliated Hospital of Xi′an Jiaotong University between January 2023 and February 2025. Additionally, 188 pregnant women with normal glucose tolerance, confirmed by oral glucose tolerance test(OGTT), were enrolled as control group. The participants in the control group were matched 1∶1 with the GDM group based on age, pre-pregnancy body mass index(BMI), and gestational age. The ZJU index, PIV, and homeostasis model assessment of insulin resistance(HOMA-IR) levels were compared between the two groups. Spearman rank correlation analysis was performed to evaluate the correlations of ZJU index and PIV with HOMA-IR in GDM patients. Furthermore, the GDM patients were stratified into a poor neonatal outcome group(n=51) and a favorable neonatal outcome group(n=137) based on neonatal outcomes. Multivariate logistic regression analysis was employed to identify factors affecting neonatal outcomes of the GDM patients. The predictive performance of ZJU index and PIV for poor neonatal outcomes in the GDM patients was assessed using receiver operating characteristic(ROC) curve analysis. Results The levels of ZJU index, PIV and HOMA-IR in the GDM group were significantly higher than those in the control group(P<0.05). Spearman correlation analysis revealed positive correlations of ZJU index(rs=0.694, P<0.001) and PIV(rs=0.617, P<0.001) with HOMA-IR in the GDM patients. Multivariate logistic regression analysis indicated that elevated levels of HOMA-IR［OR(95%CI)=1.407(1.203-1.646)］, ZJU index［OR(95%CI)=1.356(1.203-1.528)］ and PIV［OR(95%CI)=1.107(1.064-1.153)］ were independent risk factors for poor neonatal outcomes in the GDM patients(P<0.05). Both ZJU index and PIV demonstrated effective predictive capabilities for poor neonatal outcomes(P<0.05). Notably, the combined use of the two indicators yielded superior predictive performance compared to either indicator alone(Zcombination of the two indicators-ZJU index=3.758, P<0.001; Zcombination of the two indicators-PIV=3.418, P=0.001), with a sensitivity of 78.43% and a specificity of 81.02%. Conclusion Elevated ZJU index and PIV are associated with increased IR and poor neonatal outcomes in pregnant women with GDM. The combined assessment of the two indicators may facilitate risk stratification management for the GDM patients, thereby improving maternal and neonatal prognoses. |
| Key words: gestational diabetes mellitus(GDM) Zhejiang University(ZJU) index pan-immune-inflammation value(PIV) insulin resistance(IR) neonatal outcomes |
