妊娠糖尿病患者尿液8-oxo-Gsn 表达水平及其对妊娠结局预测价值研究

目的 探讨妊娠糖尿病（gestational diabetes mellitus，GDM）患者尿液RNA 氧化标志物8G- 氧化鸟苷（8-oxo-7,8-dihydroguanosine，8-oxo-Gsn）的水平及与妊娠结局的关系。方法 选取2018 年2 月～ 2021 年2 月汉川市中医医院收治的106 例GDM 患者为观察组，根据妊娠结局情况分为妊娠结局良好组和妊娠结局不良组。另选取同期进行体检的90 例健康孕妇为对照组。收集所有孕妇的临床资料并进行比较。采用同位素稀释高效液相- 串联质谱法（isotopedilution high performance liquid phase-tandem mass spectrometry，ID-LC-MS/MS）分析尿液中8-oxo-Gsn 水平。采用ROC曲线评估8-oxo-Gsn 对GDM 患者不良妊娠结局的评估价值。多因素回归分析影响GDM 患者不良妊娠结局的危险因素。结果 与对照组相比，观察组尿液8-oxo-Gsn 水平（3.89±0.63 μmol/mol vs 2.26±0.47 μmol/mol）及不良妊娠结局的发生率（29.25% vs 11.11%）明显升高，差异有统计学意义（t=20.225，χ2=9.676，均P ＜ 0.05）。与妊娠结局良好组相比，妊娠结局不良组患者尿液8-oxo-Gsn 水平（4.67±0.77 μmol/mol vs 3.56±0.57μmol/mol）升高，差异有统计学意义（t=8.197，P ＜ 0.05）。ROC 曲线分析结果显示，8-oxo-Gsn 预测GDM 患者不良妊娠结局的曲线下面积为0.847，截断值为4.049 μmol/mol，敏感度和特异度分别为77.40%，81.30%。HOMA-IROR（95%CI）:4.726（2.027 ～ 11.021）]，8-oxo-GsnOR（95%CI）:5.591（2.239 ～ 13.964）] 是GDM 患者发生不良妊娠结局的独立危险因素（均P ＜ 0.05）。结论 GDM 患者尿液8-oxo-Gsn 水平升高，与患者不良妊娠结局有关，且对不良妊娠结局具有较优的预测价值。

Urinary 8-oxo-Gsn Expression Level in Patients with Gestational Diabetes Mellitus and Its Predictive Value for Pregnancy Outcome

Objective To investigate the level of urine RNA oxidation marker 8-oxo-7 and 8-dihydroguanosine (8-oxo-Gsn) in patients with gestational diabetes (GDM), and its relationship with pregnancy outcome. Methods A total of 106 GDM patients admitted to Hanchuan Hospital of Traditional Chinese Medicine from February 2018 to February 2021 were selected as the observation group, and divided into good pregnancy outcome group and bad pregnancy outcome group according to the pregnancy outcome. Another 90 healthy pregnant women who underwent physical examination during the same period were selected as the control group. The clinical data of all pregnant women were collected and compared. The level of 8-oxo-Gsn in urine of all pregnant women was analyzed by isotope dilution high performance liquid phase-tandem mass spectrometry (ID-LCMS/ MS). ROC curve was used to analyze the evaluation value of 8-oxo-Gsn for adverse pregnancy outcomes in GDM patients. Multivariate regression analysis affected risk factors for adverse pregnancy outcomes in GDM patients. Results Compared with the control group, the urine 8-oxo-Gsn level (3.89±0.63 μmol/mol vs 2.26±0.47 μmol/mol) and the incidence of adverse pregnancy outcomes (29.25% vs 11.11%) in the observation group were increased, and the differences were statistically significant (t=20.225, χ2=9.676, all P < 0.05). Compared with the good pregnancy outcome group, the urine 8-oxo-Gsn level (4.67±0.77 μmol/mol vs 3.56±0.57 μmol/mol) of pregnant women in the poor pregnancy outcome group was higher, and the difference was statistically significant (t=8.197, P<0.05). ROC curve analysis results showed that 8-oxo-Gsn predicted the area under the curve of pregnancy outcome in GDM patients was 0.847, the cut-off value was 4.049 μmol/mol, the sensitivity and the specificity were 77.40%, 81.30%，respectively. HOMA-IR OR (95% CI): 4.726 (2.027 ～ 11.021)], 8-oxo-Gsn OR (95% CI): 5.591 (2.239 ～ 13.964)] were independent risk factors for adverse pregnancy outcomes in GDM patients (all P<0.05). Conclusion Increased urine 8-oxo-Gsn level in GDM patients was associated with adverse pregnancy outcomes and has a better predictive value for adverse pregnancy outcomes.