生殖医学杂志

目的 探讨唾液晚期糖基化终产物(s-AGEs)用于无创监测妊娠期糖尿病(GDM)血糖控制情况的价值，并尝试建立其妊娠特异性临界值体系。方法 本研究为前瞻性随机对照研究。选取2023年1月至2024年12月于本院行常规产前检查的174例妊娠期糖尿病(GDM)患者作为研究组，另选择同时间段于本院行常规产前检查的176例健康妊娠妇女作为对照组，比较2组受试者的一般资料及孕24、28、30、32、34、36周血糖控制水平[包括空腹血糖(FPG)、餐后1 h血糖(1 h PG)、餐后2 h血糖(2 h PG)、葡萄糖目标范围内时间(TIR)];比较2组受试者孕24、28、30、32、34、36周s-AGEs水平。采用Pearson相关性分析探讨s-AGEs与血糖控制水平的相关性；使用受试者工作特征(ROC)曲线分析s-AGEs水平对GDM患者血糖控制效果的特异性临界值及预测价值。结果 (1)两组受试者的一般资料比较均无显著性差异(P>0.05)。研究组患者孕24、28、30、32、34、36周FPG、1 h PG、2 h PG及s-AGEs水平均显著高于对照组，TIR均显著低于对照组(P均<0.05);且研究组患者s-AGEs水平随孕周增加呈升高趋势，其中孕24周与孕28周、孕30周与32孕周、孕34周与孕36周差异均有统计学意义(P<0.05)。(2)研究组中血糖控制不达标组患者的s-AGEs水平随孕周增加显著升高(P<0.05),且孕24、28、30、32、34、36周s-AGEs水平均显著高于血糖控制达标组(P<0.05)。(3)Pearson相关性分析结果显示，研究组GDM患者孕24、28、30、32、34、36周s-AGEs水平与FPG、1 h PG、2 h PG分别呈显著正相关，与TIR呈显著负相关(P均<0.05);ROC分析结果显示孕24、28、30、32、34、36周s-AGEs水平预测GDM患者血糖控制效果的临界值分别为8.60 U/mg、8.74 U/mg、8.88 U/mg、8.95 U/mg、9.34 U/mg、9.57 U/mg,各孕周s-AGEs水平联合预测GDM患者血糖控制效果的ROC曲线下面积(AUC)显著高于单独预测(P<0.05)。结论 与健康妊娠妇女相比，GDM患者孕24、28、30、32、34、36周的s-AGEs水平均升高，s-AGEs水平与患者血糖控制水平有关，以上各孕周s-AGEs水平联合检测对GDM患者血糖控制效果的预测价值较高。

Objectives:To establish a pregnancy-specific critical value system for non-invasive monitoring of blood glucose control in gestational diabetes mellitus(GDM) based on salivary advanced glycation end products(s-AGEs).Methods:This study is a prospective randomized controlled trial. A total of 174 pregnant women with gestational diabetes mellitus(GDM) who underwent routine prenatal examination in Suqian First People's Hospital from January 2023 to December 2024 were selected as the study group, and 176 healthy pregnant women who underwent routine prenatal examination in the same hospital and during the same period were selected as the control group. The general information of the two groups and their blood glucose control levels at the 24^th,28^th,30^th,32^nd,34^th and 36^th weeks of gestation [fasting plasma glucose(FPG),1 hour postprandial plasma glucose(1 h PG),2 hours postprandial plasma glucose(2 h PG),and glucose time in range(TIR)] were compared. The levels of s-AGEs in two groups at the 24^th,28^th,30^th,32^nd,34^th and 36^th weeks of gestation were compared. Pearson correlation analysis was used to explore the correlation between s-AGEs and blood glucose control level. Receiver operating characteristic(ROC) curves were used to analyze the specific critical value and predictive value of s-AGEs levels on the blood glucose control effect of GDM patients.Results:There were no significant differences in general characteristics between the two groups(P>0.05). The FPG,1 h PG,2 h PG and s-AGEs levels in the study group were higher than those in the control group at the 24^th,28^th,30^th,32^nd,34^th and 36^th weeks of gestation, and the TIR were lower than those in the control group(P all <0.05). The s-AGEs level in the study group increased with the increase of gestational weeks, and among them, the differences between the 24^th week and the 28^th week of gestation, the 30^th week and the 32^nd week of gestation, and the 34^th week and the 36^th week of gestation were statistically significant(P<0.05). Among the study group, the s-AGEs level in patients whose blood glucose control did not meet the standard increased with the increase of gestational weeks, and the differences were statistically significant(P<0.05),and were higher than those whose blood glucose control reached the standard at the 24^th,28^th,30^th,32^nd,34^th and 36^th weeks of gestation(P<0.05). The Pearson correlation analysis results showed that the s-AGEs levels in GDM patients at the 24^th,28^th,30^th,32^nd,34^th and 36^th weeks of gestation were positively correlated with FPG,1 h PG,and 2 h PG respectively, and negatively correlated with TIR(P all <0.05). The ROC analysis results showed that the critical values for predicting the blood glucose control effect in GDM patients based on s-AGEs values at the 24^th,28^th,30^th,32^nd,34^th and 36^th weeks of gestation were 8.60 U/mg, 8.74 U/mg, 8.88 U/mg, 8.95 U/mg, 9.34 U/mg and 9.57 U/mg, respectively. The area under the ROC curve(AUC) of blood glucose control effect in GDM patients predicted by s-AGEs levels at each gestational week was higher than those predicted separately(P<0.05).Conclusions:Compared to healthy pregnant women, the s-AGEs levels of GDM patients at the 24^th,28^th,30^th,32^nd,34^th and 36^th weeks of gestation were all increased, and the s-AGEs levels were related to the patient's blood glucose control level. The combined detection of s-AGEs levels at the above gestational weeks has a high predictive value for the blood glucose control effect in GDM patients.