Background: We aimed to estimate the performance of amino acids levels in predicting the risk of subsequent gestational diabetes mellitus (GDM).
Methods: A total of 431 women at 12 to 16 weeks of gestation in the Department of Obstetrics and Gynecology of the Second Affiliated Hospital of Soochow University were recruited. High-performance liquid chromatography electrospray tandem mass spectrometry was used to measure amino acids levels in maternal blood at 12 to 16 weeks of gestation. At 24 to 28 weeks of gestation, all participants were administered 75-g oral glucose tolerance tests for the diagnosis of GDM.
Results: Alanine, isoleucine, and tyrosine levels in early pregnancy were significantly different between women who developed GDM and those who remained normal glucose tolerant. Logistic regressions showed that after adjustments for age, parity, body mass index, family history of diabetes, γ-glutamyltranspeptidase, triglycerides, fasting glucose and fasting insulin levels, alanine (odds ratio [OR], 1.46; 95% CI, 1.05-2.04; P = .027), isoleucine (OR, 1.48; 95% CI, 1.12-1.96; P = .0062), and tyrosine (OR, 1.46; 95% CI, 1.07-2.03; P = .020) levels in early pregnancy were independently associated with subsequent GDM. The addition of isoleucine and tyrosine into the conventional model improved the area under curve from 0.692 to 0.737 (P = .036) and significantly increased the net reclassification improvement (+13.7%, P = .0025).
Conclusions: The present study suggests that elevated isoleucine, tyrosine, and alanine levels are independently and significantly associated with subsequent incidence of GDM. New models including conventional risk factors, isoleucine and tyrosine levels in early pregnancy might help physicians identify high-risk population of GDM.
背景: 本文旨在分析妊娠早期的氨基酸水平在预测妊娠期糖尿病(GDM)发病风险中发挥的作用。 方法: 选取431名在苏州大学附属第二医院妇产科产检受孕12至16周的孕妇, 利用高效液相色谱电喷雾串联质谱法, 测定妊娠早期血清氨基酸水平, 在孕24-28周时, 所有受访者均接受75g口服葡萄糖耐量试验以诊断妊娠期糖尿病。 结果: GDM患者与糖耐量正常人群相比, 妊娠早期的丙氨酸、异亮氨酸和酪氨酸水平存在显著差异。Logistic回归分析发现, 在校正了年龄、胎次、体重指数、糖尿病家族史、γ-谷氨酰转肽酶、甘油三酯、空腹血糖和空腹胰岛素水平这些危险因素后, 妊娠早期的丙氨酸(OR, 1.46; 95%CI, 1.05-2.04 ; P = .027), 异亮氨酸(OR, 1.48; 95%CI, 1.12-1.96; P = .0062)和酪氨酸(OR, 1.46; 95%CI, 1.07-2.03; P = .020)水平与GDM发病独立相关。在常规模型中加入异亮氨酸和酪氨酸后, 可将曲线下面积从0.692增至0.737(P = .036), 同时显著增加了重分类改善指标(+ 13.7%, P = .0025)。 结论: 本研究发现升高的异亮氨酸、酪氨酸和丙氨酸水平与GDM发病存在独立且显著的相关性。建立包括常规危险因素和妊娠早期异亮氨酸和酪氨酸水平在内的新模型, 将有助于临床医生识别GDM发病的高危人群。.
Keywords: amino acid; early pregnancy; gestational diabetes; metabolomics; prediction; 代谢组学; 妊娠早期; 妊娠期糖尿病; 氨基酸; 预测.
© 2019 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.