| ObjectiveTo investigate the correlation between UCPCR(urinary c peptide/creatinine ratio),PVUCP(product of urine volume and urinary C peptide)and classical markers of ?-cell function in pregnancy with or without impaired glucose metablism.Determine whether the two index can be used as an evaluation indicator of female islet function in pregnancy.And furthermore,to be used for the diagnosis and screening of GDM(gestational diabetes mellitus)MethodsWe recruited pregnant women between 24 to 28 weeks,whose fasting glucose were equal to or more than 4.4mmol/l.Firstly,measured height,weight,and calculate thd BMI;Secondly,75g oral glucose tolerance test were performed.The blood samples of 0 minutes,60 minutes and 120 minutes were collected for detection of blood glucose,blood insulin,C peptide level,which were necessary to calculate HOMA IR,HOMA-beta,Matsuda,DI index,insulin area under curve and C peptide area under the curve.Thirdly,the urine samples of 0 minutes,60 minutes and 120 minutes were collected to test urine C peptide and urine creatinine,the urine volumn should be recorded seperatedly.Lastly,the ratio of urinary C peptide/urine creatinine,production of urine C peptide and urine volume would be calculatedResults1.General conditions of the enrolled patientsThis study enrolled 166 cases finally,41 cases of which were diagnosed with GDM,accounts for the proportion of 24.7%.The average age of GDM was 27.70 years old,and the average gestational age was 25.57 weeks,6 cases had a strong family history of diabetes.In the normal pregnancy group,125 patients,with an average age of 28.20 years,had an average gestational age of 25.80 weeks,with 15 cases of family history of diabetes.There was no significant difference between the two groups(P<0.05).2.Comparison of clinical data between GDM and normal pregnancy:Pregnancy in GDM group had higher BMI(22.13±2.63kg/m2 vs.20.31±2.71kg/m2,P=0.000),the FIns(10.40±6.84uU/ml vs.7.42±3.22uU/ml,P=0.014),FCP(2.51±0.84ng/ml vs.1.87±0.67ng/ml,P=0.001),PVUCP1-2(17.36±10.78ug vs.11.34±65.06ug,P=0.033),PVUCP2(28.05±14.13ug vs.20.52±10.53ug,P=0.000),CPauc(1187.69±400.53 vs.981.15±322.46,P=0.014),HOMA IR(2.43 ±1.58 vs.1.54±0.71,P=0.000)than normal pregnancy group,but Matsuda index(21.33±9.20 vs.32.37±13.56,P=0.000),DI index(52.22±13.41 vs.93.43±29.31,P=0.000)was lower in GDM group.3.Correlation analysis of UCPCR with other index:Fasting UCPCR in GDM group was positively correlated with fasting blood insulin(r=0.464,p=0.002)and C peptide(r=0.396,p?0.010),and negatively correlated with the Matsuda index(r=0.473,p=0.002);UCPCR of 60 minutes was positively related with HOMA-beta(r=0.366,p=0.019),and showed no correlation with other index;UCPCR of 120 minutes was positively correlated with insulin of 120 minutes(r=0.411,p=0.08),C peptide of 120 minutes(r=0.333,p=0.033),insulin area under the curve(r=0.337,p=0.031)and C peptide area under the curve(r=0.339,p=0.030),and negatively correlated with Matsuda index(r=0.368,p=0.018).In the normal pregnancy group,the UCPCR of each point was positively correlated with the blood insulin of the corresponding time point(0 minute r=0.391,p=0.000;60 minutes r=0.209,p=0.020;120 minutes r=0.211,p=0.018),fasting C peptide(r=0.425,p=0.000),C peptide of 60 nimutes(r=0.277,p=0.002),and negatively correlated with Matsuda index.Fasting UCPCR was positively correlated with HOMA-beta(r=0.282,p?0.002)and HOMA IR(r?0.396,p=0.000),and negatively correlated with DI(r=0.248,p=0.005).UCPCR of 120 minutes was positively correlated with insulin area under the curve(r=0.220,p=0.010)and C peptide area under the curve(r?0.229,p=0.011).4.Correlation analysis of PVUCP with other index:Fasting PVUCP in GDM group and HOMA-beta(r=0.393,p=0.011)were positively correlated,and the Matsuda index(r?0.328,p=0.036)showed a negative correlation;PVUCP of 60 minutes had no obvious correlation with other index;PVUCP of 120 minutes was positively correlated with blood insulin(r=0.367,p=0.018)and C peptide(r?0.317,p?0.043)of the corresponding time point,and negatively correlated with Matsuda index(r=0.350,p=0.025).With insulin area under the curve and C peptide area under the curve,there was no correlation.Fasting PVUCP in normal pregnancy group was positively correlated with fasting blood insulin(r=0.246,p=0.006),C peptide(r=0.188,p=0.036),HOMA ?beta(r=0.223,p=0.012)and HOMA IR(r=0.240,p=0.007),and the Matsuda index(r=0.275,p=0.012)showed a negative correlation;PVUCP of 60 minutes was positively correlated with insulin of 60 minutes(r=0.206,p=0.021),C peptide of 60 minutes(r=0.298,p=0.001)and HOMA IR(r=0.287,p=0.001),and negatively correlanted with the Matsuda index(r?0.324,p=0.000)and DI(r=0.225,p?0.012);PVUCP of 120 minutes was positively correlated with insulin(r=0.367,p=0.003),C peptide(r=0.210,p=0.019)of corresponding time point,insulin area under the curve(r?0.230,p=0.010)and C peptide area under the curve(r=0.225,p=0.012),and negatively correlated with Matsuda index(r=0.213,p=0.017).PVUCP2 in the two groups were positively correlated with insulin of 120 miutes,C peptide of 120 miutes,HOMA-IR insulinarea under the curve,c-peptide area under the curve,respectively.5.Predictors of gestational diabetes mellitus:HOMA-IR,PVUCP2 diagnosis efficiency is relatively high.The highest area under the ROC curve for independently predicting gestational diabetes mellitus was found in HOMA-IR(0.735,P?0.000),the cut point for diagnosis was 1.9.The sensitivity of diagnosis was 68.3%,and specificity was 72.0%.The cut point of PVUCP2 for prediction of gestational diabetes mellitus was 32.3 ug,the area under the ROC curve was 0.658(P=0.001),which had sensitivity of 43.9%,specificity of 87.4%.Conclusions1.The incidence of gestational diabetes mellitus is 24.7%in our study,the GDM group has a higher BMI,fasting insulin and fasting c-peptide levels.The GDM group has higher HOMA-IR,which reflect the insulin resistance,and lower Matsuda index,which reflect the insulin sensitivity.2.Fasting UCPCR and 120 minutes' UCPCR are not suitable for diagnosis of gestational diabetes mellitus,but can reflect to some extent islet function in pregnancy.3.PVUCP can reflect the base insulin secretion capacity in pregnancy women.4.PVUCP2 can reflect the insulin secretion capacity after glucose stimulation in pregnancy women and the degree of insulin resistance,and which are significantly higher in GDM group than in normal pregnancy group.5.HOMA-IR and PVUCP2 have higher efficiency to predict gestational diabetes mellitus in our study.The cutpoint for diagnosis was 1.9 in HOMA-IR,and 32.3 ug in PVUCP2 respectively. |
PDF Full Text Request