Research On The Relationship Between Osteoprotegerin And Gestational Diabetes Mellitus

? Background? The incidence rate of pregnancy complicated with diabetes was 2%-18%,90% of which is gestational diabetes?GDM?.GDM not only can lead to adverse pregnancy outcomes and threaten thesafety of the mother and fetus,but also have a long-term risk of developing type 2 diabetes and cardiovascular disease.At present,the pathogenesis of GDM is not clear and the incidence rate is increasing all aroud the world,so clinicians and researchers are facing serious challenges.Osteoprotegerin?OPG?is a secreted glycoprotein,which is a member of the tumor necrosis factors?TNF?superfamily,and is combined with receptor activator of nuclear factor kappa B ligand?RANKL?and TNF related apoptosis inducing ligand?TRAIL?,which may affect the peripheral activities related to cell survival and death,and it greatly effects on the skeletal,vascular,immune and endocrine systems.Studies have shown that OPG is involved in the existence and development of Type 2 diabetes by amplifying inflammation and glucose-lipid metabolism disorder.At present,there are few studies about the correlation between OPG and GDM.This study is intend to explore the correlation between OPG and GDM,in order to find the potential GDM markers and provide evidence for early screening,prediction,prevention,diagnosis and treatment of GDM.?Objectives? By measuring serum OPG concentrations in GDM and normal glucose tolerance?NGT?pregnant women and analyzing relevant clinical indicators,we aim to evaluate the change trend of serum OPG concentrations in the second and third trimesters of pregnancy,and investigate the relationship between serum OPG and GDM and related clinical indicators.?Methods? The study enrolled a total of 69 GDM and 109 NGT pregnant women whose were documented,examined,and confined at the Shenzhen Maternal and Child Health Hospital from April 2017 to April 2018,and had recorded basic information such as pregnancy history,gestational weeks,blood pressure,BMI,age,etc.After diagnosis of GDM,the subjects were guided by medical nutrition therapy and exercise education,and when necessary,insulin was used to control blood glucose.There were 64 cases of GDM patients and 101 NGT pregnant women whom were followed up to the mature.At the time of OGTT examination and before mature delivery,5 ml of venous blood was collected,and the upper layer serum was stored in-80? refrigerator after centrifugation,which would be used ELISA method to detect serum OPG levels.The indexes of FPG,1h BG,2h BG,Fins,Hb A1 c,TC,TG,HDL-C,LDL-C,CR,BUN,ALT,AST and so on were detected by the hospital examination department.HOMA-IR was used to assess insulin resistance.All data are analyzed by SPSS 13 and Prism software.?Results? 1.Comparison of general data in the second trimester pregnant women: the age,pregnant BMI,systolic blood pressure and diastolic blood pressure of GDM group are higher than the NGT group,the differences are statistically significant?P < 0.05?.There are no statistically significant differences in gestational history,gestational weeks and p BMI?P>0.05?.2.Comparison of general data in the third trimester pregnant women: There are no statistically significant differences in BMI,systolic blood pressure and diastolic blood pressure between the two groups?P > 0.05?.3.Comparison of the biochemical indicators in the second trimester pregnant women: The FPG,1h BG,2h BG,Fins,HOMA-IR,Hb A1 c,TG,LDL-C and BUN of GDM group are higher than NGT group,and the HDL-C is lower than NGT group,the differences are statistically significant?P < 0.05?.There are no statistically significant differences in ALT,AST,TC and Cr between the two groups?P > 0.05?.4.Comparison of biochemical indicators in the third trimester pregnant women: The TG and BUN of GDM group are higher than NGT group,and the TC and LDL-C of GDM group are lower than NGT group,the differences are statistically significant?P<0.05?.There are no statistically significant differences in FPG,Hb A1 c,HDL-C,Cr,ALT and AST between the two groups?P > 0.05?.5.Comparison of Serum OPG concentration in pregnant women: The second trimester of GDM group is higher than the second trimester of NGT Group?814.00± 99.62 VS 342.70 ± 26.07?,and the third trimester of GDM group is higher than the third trimester of NGT group?1507.00 ± 123.10 VS 818.10 ± 58.20?,and the third trimester of NGT group is higher than in second trimester of NGT group?818.10 ± 58.20 VS 342.70 ± 26.07?,and the third trimester of GDM group is higher than the second trimester of GDM group?1507.00 ± 123.10 VS 814.10 ± 99.62?,the differences are statistically significant?P < 0.05?.6.The correlation and regression analysis between Serum OPG concentration and clinical indicators: There are significant positive correlation with the serum OPG and FPG,1h BG,2h BG,Fins,HOMA-IR,Hb A1 c,TG,LDL-C,BMI,SBP,DBP.There are no correlation with the serum OPG and TC,HDL-C,age and p BMI.With the serum OPG concentration of pregnant women as the dependent variable,multiple linear regression analysis is carried out with the above correlation index as the independent variable.The results showed that HOMA-IR and TG entered the regression equation,and the regression equation was: ???=-1184.73+11.07X-_HOMA-IR+117.78X_TG?Conclusions? 1.HOMA-IR and TG are independent risk factors for the elevation OPG concentration in GDM patients,suggesting that glycolipid metabolism disorder and insulin resistance in GDM patients may feed back to promotion the expression of OPG.Therefore,OPG can be used as a molecular marker for predicting metabolic abnormalities in GDM patients.2.The expression of serum OPG concentrations is significantly increased in GDM patients,suggesting that OPG may be involved in the pathophysiological process of GDM existence and development,and OPG may be the relevant target of GDM etiology.