【摘要】 探究妊娠期糖尿病(GDM)孕妇血清铁蛋白(SF)、核因子-κB(NF-κB)变化与胰岛素抵抗(IR)程度及不良妊娠结局的关系。选取2020年5月—2023年2月本院收治的GDM孕妇115例为观察组，另选取同期产检的115例耐糖量正常产妇为对照组，检测比较两组血清SF、NF-κB水平、血糖[空腹血糖(FPG)、餐后2 h血糖(2h PG)]及IR生化指标[空腹胰岛素(FINS)、胰岛素分泌指数(IS)、胰岛素抵抗指数(HOMR-IR)],根据HOMR-IR划分IR程度，比较不同IR程度血清SF、NF-κB水平；随访并记录两组妊娠结局，比较GDM孕妇不同妊娠结局血清SF、NF-κB水平，分析其血清SF、NF-κB水平与IR程度、妊娠结局的相关性及SF、NF-κB联合检测对GDM孕妇不良妊娠结局的预测价值。观察组血清SF、NF-κB水平均高于对照组[(49.31±12.53)μg/L、(14.86±4.71) ng/mL vs(24.63±9.63)μg/L、(8.63±2.73) ng/mL;P<0.05];观察组FPG、2h PG、FINS、HOMR-IR均高于对照组，IS低于对照组[(4.97±0.61) mmol/L、(9.79±0.83) mmol/L、(10.57±2.68)μU/mL、(2.13±0.46)%、(2.33±0.86)%vs(4.23±0.68) mmol/L、(8.01±0.62) mmol/L、(9.73±3.17)μU/mL、(2.30±0.57)%、(1.83±0.74)%;P<0.05];两组不良妊娠结局发生率比较(42.61%vs 18.26%)差异有统计学意义(χ~2=16.100,P<0.001);GDM孕妇不同IR程度血清SF、NF-κB水平比较，HOMR-IR(0～1)<HOMR-IR(1～2)<HOMR-IR(2～3)<(HOMR-IR>3)[(26.89±9.75)<(42.82±10.06)<(51.16±10.25)<(62.17±11.47)μg/L;(8.94±2.65)<(12.71±4.11)<(15.01±4.53)<(19.74±4.60) ng/mL;P<0.05];GDM孕妇不良妊娠结局GDM孕妇血清SF、NF-κB水平均高于良好妊娠结局孕妇[(74.62±10.59)μg/L、(19.16±4.57) ng/mL vs(30.52±10.84)μg/L、(9.07±2.95) ng/mL;P<0.05];GDM孕妇血清SF、NF-κB水平与IR程度(r=0.746、0.612)、妊娠结局(r=0.811、0.793)均呈正相关(P<0.05);血清SF、NF-κB联合预测GDM孕妇不良妊娠结局的AUC为0.913,大于SF、NF-κB单独预测(P<0.05)。GDM孕妇血清SF、NF-κB异常表达，且与IR程度及不良妊娠结局联系密切，联合检测SF、NF-κB有利于预测GDM孕妇不良妊娠结局。更多还原

【Abstract】 To investigate the relationship between serum ferritin(SF),nuclear factor-κB(NF-κB) and insulin resistance(IR) and adverse pregnancy outcomes in pregnant women with gestational diabetes mellitus(GDM),a total of 115 pregnant women with GDM treated in the authors’ hospital from May 2020 to February 2023 were selected as the observation group, and 115 pregnant women with normal glucose tolerance during the same period were selected as the control group.Serum SF,NF-κB levels, blood glucose[fasting blood glucose(FPG),2h post-meal blood glucose(2h PG)] and IR biochemical indices[fasting insulin(FINS),insulin secretion index(IS),insulin resistance index(HOMR-IR)] were detected and compared between the two groups.IR levels were divided according to HOMR-IR.The levels of serum SF and NF-κB in different IR levels were compared.Pregnancy outcomes of the two groups were followed up and recorded.Serum SF and NF-κB levels were compared in pregnant women with different pregnancy outcomes of GDM,and the correlation between serum SF and NF-κB levels and the degree of IR and pregnancy outcomes was analyzed, and the predictive value of combined detection of SF and NF-κB in adverse pregnancy outcomes of pregnant women with GDM was analyzed.The levels of serum SF and NF-κB in observation group were higher than those in control group[(49.31±12.53) μg/L,(14.86±4.71) ng/mL vs(24.63±9.63) μg/L,(8.63±2.73) ng/mL; P<0.05].FPG,2h PG,FINS and HOMR-IR in observation group were higher than those in control group.IS was lower than control group[(4.97±0.61) mmol/L,(9.79±0.83) mmol/L,(10.57±2.68) μU/mL,(2.13±0.46)%,(2.33±0.86)% vs(4.23±0.68) mmol/L,(8.01±0.62) mmol/L,(9.73±3.17) μU/mL,(2.30±0.57)%,(1.83±0.74)%; P<0.05];There is a statistically significant difference in the incidence of adverse pregnancy outcomes between the two groups(42.61% vs 18.26%)(χ~2=16.100,P<0.001);Comparison of serum SF and NF-κB levels in pregnant women with different IR levels in GDM:HOMR-IR(0～1)<HOMR-IR(1～2)<HOMR-IR(2～3)<(HOMR-IR>3)[(26.89±9.75)<(42.82±10.06)<(51.16±10.25)<(62.17±11.47) μg/L;(8.94±2.65)<(12.71±4.11)<(15.01±4.53)<(19.74±4.60) ng/mL; P<0.05];The levels of serum SF and NF-κB in GDM women with adverse pregnancy outcomes were higher than those in women with good pregnancy outcomes [(74.62±10.59) μg/L,(19.16±4.57) ng/mL vs(30.52±10.84) μg/L,(9.07±2.95) ng/mL;P<0.05];Serum SF and NF-κB levels were positively correlated with IR(r=0.746,0.612) and pregnancy outcome(r=0.811,0.793) in pregnant women with GDM(P<0.05).The AUC of the combined prediction of SF and NF-κB for adverse pregnancy outcomes in GDM pregnant women was 0.913,which was higher than that of SF and NF-κB alone(P<0.05).Abnormal expression of SF and NF-κB in serum of pregnant women with GDM is closely related to IR level and adverse pregnancy outcome.Combined detection of SF and NF-κB is beneficial to predict adverse pregnancy outcome of pregnant women with GDM.更多还原