妊娠期糖尿病患者血清miR-15a、miR-195-5p、miR-33表达及其与母婴结局的关系

doi:10.3969/j.issn.1006-5725.2025.16.014

Abstract

Abstract:

Objective To investigate the expression levels of serum microRNA-15a （miR-15a）， microRNA-195-5p （miR-195-5p）， and microRNA-33 （miR-33） in pregnant women with gestational diabetes mellitus （GDM） and to explore their associations with maternal and neonatal outcomes. Methods The research subjects were selected from 208 patients with GDM who completed delivery at our hospital between September 2021 and October 2024. Based on maternal pregnancy outcomes， the subjects were categorized into either the poor maternal outcome group or the good maternal outcome group. Similarly， they were classified into the poor perinatal outcome group and the good perinatal outcome group according to perinatal outcomes. Clinical data and serum levels of fasting plasma glucose （FPG）， miR-15a， miR-195-5p， and miR-33 were collected and compared between groups with different maternal and perinatal outcomes. Multivariate logistic regression analysis was conducted to identify risk factors associated with adverse maternal and perinatal outcomes among GDM patients. Additionally， the predictive value of these biomarkers for adverse maternal and perinatal outcomes was evaluated using receiver operating characteristic （ROC） curve analysis. Results Among 208 patients with GDM， 81 experienced adverse maternal pregnancy outcomes （38.94%）. Of the 192 newborns， 51 cases were associated with adverse perinatal outcomes， resulting in an incidence rate of 26.56%. Multivariate logistic regression analysis revealed that a high insulin resistance index （OR = 2.197）， poor glycemic control （OR = 2.482）， a history of adverse pregnancy or childbirth （OR = 2.838）， elevated FPG levels （OR = 1.910）， increased serum expression of miR-15a （OR = 1.988）， miR-195-5p （OR = 2.273）， and miR-33 （OR = 2.479） were independent risk factors for adverse maternal pregnancy outcomes in GDM patients （P < 0.05）. The area under the receiver operating characteristic curve （AUC） for the combined detection of miR-15a， miR-195-5p， and miR-33 was higher than that of FPG alone in predicting maternal pregnancy outcomes， with the combined detection showing the highest AUC （P < 0.05）. Similarly， multivariate logistic regression results also indicated that elevated levels of the aforementioned biomarkers—insulin resistance index （OR = 2.155）， poor glycemic control （OR = 2.408）， history of adverse pregnancy or childbirth （OR = 2.838）， FPG （OR = 2.018）， miR-15a （OR = 2.197）， miR-195-5p （OR = 2.246）， and miR-33 （OR = 3.043）—were independent risk factors for adverse perinatal outcomes in GDM patients （P < 0.05）. The AUC for combined detection of miR-15a， miR-195-5p， and miR-33 was significantly higher than that of FPG alone in predicting perinatal outcomes， with the combination yielding the highest predictive accuracy （P < 0.05）. Conclusions Patients with GDM are at increased risk of adverse maternal and perinatal outcomes. Elevated insulin resistance index， poor glycemic control， a history of adverse pregnancy or childbirth， and increased serum levels of miR-15a， miR-195-5p， and miR-33 were identified as independent risk factors for adverse pregnancy outcomes in individuals with gestational diabetes. The individual measurement of miR-15a， miR-195-5p， and miR-33， as well as their combined detection， demonstrated greater predictive value for pregnancy outcomes in GDM patients compared to FPG alone， with the combined detection showing the highest predictive accuracy.

Key words: gestational diabetes mellitus, micro ribonucleic acid-15a, micro ribonucleic acid-195-5p, micro ribonucleic acid-33, maternal pregnancy outcome, pregnancy outcome of perinatal infants

CLC Number:

R714.25

Haihong WANG,Cui ZHAO,Yishan LI,Shuying. CHEN. Expression of serum miR-15a， miR-195-5p， miR-33 in patients with gestational diabetes and their relationship with maternal and infant outcomes[J]. The Journal of Practical Medicine, 2025, 41(16): 2533-2540.

Figures/Tables 10

Tab.1

Clinical data of patients with different maternal pregnancy outcomes"

临床资料	母体结局不良组（n = 81）	母体结局良好组（n = 127）	t/χ² 值	P值
年龄（ $x ˉ$ ± s）/岁	31.02 ± 4.41	30.76 ± 4.32	0.420	0.675
分娩孕周（ $x ˉ$ ± s）/周	38.01 ± 2.02	37.93 ± 1.76	0.302	0.763
分娩前体质量指数（ $x ˉ$ ± s）/（kg/m²）	24.76 ± 1.65	24.82 ± 1.70	0.251	0.802
胰岛素抵抗指数（ $x ˉ$ ± s）	3.54 ± 0.65	3.11 ± 0.47	5.528	< 0.001
血糖控制情况			14.117	< 0.001
不良	38（46.91）	28（22.05）
良好	43（53.09）	99（77.95）
既往孕产史	44（54.32）	80（62.99）	1.545	0.214
不良孕产史	17（20.99）	11（8.66）	6.450	0.011
治疗方式
饮食控制	52（64.20）	86（67.72）	0.274	0.600
降糖药物	13（16.05）	21（16.54）	0.009	0.926
运动	50（61.73）	82（64.57）	0.172	0.678
分娩方式			1.077	0.299
顺产	23（28.40）	28（22.05）
剖宫产	58（71.60）	99（77.95）

Tab.1

Tab.2

Tab.3

Tab.4

Fig.1

Tab.5

Clinical data of patients with different perinatal pregnancy outcomes"

临床资料	围生儿结局不良组（n = 51）	围生儿结局良好组（n = 141）	t/χ² 值	P值
年龄（ $x ˉ$ ± s）/岁	31.98 ± 3.66	30.25 ± 3.54	2.964	0.003
分娩孕周（ $x ˉ$ ± s）/周	37.54 ± 1.87	37.86 ± 1.89	1.039	0.300
分娩前体质量指数（ $x ˉ$ ± s）/（kg/m²）	24.57 ± 1.57	24.70 ± 1.63	0.493	0.623
胰岛素抵抗指数（ $x ˉ$ ± s）	3.65 ± 0.68	3.20 ± 0.57	4.583	< 0.001
血糖控制情况			4.070	0.044
不良	19（37.25）	32（22.70）
良好	32（62.75）	109（77.3）
既往孕产史	33（64.71）	87（61.70）	0.144	0.704
不良孕产史	11（21.57）	10（7.09）	8.057	0.005
治疗方式
饮食控制	30（58.82）	95（67.38）	1.206	0.272
降糖药物	9（17.65）	22（15.60）	0.116	0.734
运动	12（23.53）	24（17.02）	1.041	0.308
分娩方式			0.623	0.430
顺产	14（27.45）	31（21.99）
剖宫产	37（72.55）	110（78.01）

Tab.5

Tab.6

Tab.7

Tab.8

Fig.2

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指标	母体结局不良组（n = 81）	母体结局良好组（n = 127）	t值	P值
FPG/(mmol/L)	5.33 ± 0.93	4.97 ± 0.62	3.350	0.001
miR-15a	4.09 ± 0.54	3.26 ± 0.48	11.578	< 0.001
miR-195-5p	2.34 ± 0.43	1.28 ± 0.30	20.930	< 0.001
miR-33	1.54 ± 0.25	0.99 ± 0.18	18.421	< 0.001

变量	β	SE	Wald χ²	P值	OR	95%CI
胰岛素抵抗指数高	0.787	0.387	4.135	0.042	2.197	1.029 ~ 4.690
血糖控制不良	0.909	0.118	59.342	< 0.001	2.482	1.969 ~ 3.128
有不良孕产史	1.043	0.387	7.264	0.007	2.838	1.329 ~ 6.059
血清FPG水平升高	0.647	0.201	10.361	0.001	1.910	1.288 ~ 2.832
血清miR-15a表达水平升高	0.687	0.117	34.478	< 0.001	1.988	1.580 ~ 2.500
血清miR-195-5p表达水平升高	0.821	0.279	8.659	0.003	2.273	1.315 ~ 3.927
血清miR-33表达水平升高	0.908	0.308	8.691	0.003	2.479	1.356 ~ 4.534

指标	截断值	AUC	敏感度/%	特异度/%	P值	95%CI
FPG	5.12	0.601	61.73	60.63	< 0.001	0.531 ~ 0.668
miR-15a	3.68	0.796^*	72.84	75.59	< 0.001	0.735 ~ 0.848
miR-195-5p	1.88	0.807^#	76.54	73.23	< 0.001	0.747 ~ 0.859
miR-33	1.01	0.797^&	72.84	74.02	< 0.001	0.736 ~ 0.849
miR-15a、miR-195-5p、miR-33联合检测	-	0.879^*#&%	81.48	81.89	< 0.001	0.827 ~ 0.920

指标	围生儿结局不良组（n = 51）	围生儿结局良好组（n = 141）	t值	P值
FPG	5.27 ± 0.87	4.94 ± 0.71	2.674	0.008
miR-15a	3.98 ± 0.56	3.30 ± 0.49	8.170	< 0.001
miR-195-5p	2.34 ± 0.43	1.42 ± 0.37	14.560	< 0.001
miR-33	1.60 ± 0.23	0.96 ± 0.20	18.802	< 0.001

变量	β	SE	Wald χ²	P值	OR	95%CI
年龄大	0.565	0.665	0.722	0.396	1.759	0.478 ~ 6.478
胰岛素抵抗指数高	0.768	0.232	10.958	0.001	2.155	1.368 ~ 3.396
血糖控制不良	0.879	0.234	14.111	< 0.001	2.408	1.523 ~ 3.810
有不良孕产史	1.043	0.308	11.467	0.001	2.838	1.552 ~ 5.190
血清FPG水平升高	0.702	0.198	12.570	< 0.001	2.018	1.369 ~ 2.975
血清miR-15a表达水平升高	0.787	0.212	13.781	< 0.001	2.197	1.450 ~ 3.328
血清miR-195-5p表达水平升高	0.809	0.187	18.716	< 0.001	2.246	1.557 ~ 3.240
血清miR-33表达水平升高	1.113	0.213	27.304	< 0.001	3.043	2.005 ~ 4.620

Expression of serum miR-15a， miR-195-5p， miR-33 in patients with gestational diabetes and their relationship with maternal and infant outcomes

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指标	截断值	AUC	敏感度/%	特异度/%	P值	95%CI
FPG	5.13	0.626	62.75	60.28	< 0.001	0.553 ~ 0.694
miR-15a	3.41	0.695^*	68.63	62.41	< 0.001	0.625 ~ 0.759
miR-195-5p	1.90	0.672^*	64.71	68.79	< 0.001	0.600 ~ 0.738
miR-33	1.30	0.724^*	70.59	69.50	< 0.001	0.655 ~ 0.786
miR-15a、miR-195-5p、miR-33联合检测	-	0.898^*#&%	82.35	87.23	< 0.001	0.846 ~ 0.937

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