摘要目的:研究血清脂肪酸结合蛋白4（FABP4）、血清25-羟基维生素D[25（OH）D]及血清内脂素（Visfatin）对判断高龄妊娠期糖尿病（GDM）孕妇发生骨质疏松症（OP）的预测价值。方法:选取2021年5月至2024年5月青岛市市立医院东院收治的120例高龄GDM孕妇，孕期发生OP者为观察组（16例），未发生OP者为对照组（104例）。比较两组患者血清FABP4、25（OH）D及Visfatin水平，采用Logistic多因素模型分析高龄GDM孕妇发生OP的相关因素，建立风险预测回归模型，分析各因素及模型的判断价值。结果:120例高龄GDM孕妇中，16例发生OP，发生率为13.33%。Logistic多因素分析显示，血清FABP4（ β=1.074，95% CI=1.675~5.111， P<0.001）和血清Visfatin（ β=1.306，95% CI=2.156~6.322， P<0.001）是高龄GDM孕妇并发OP的独立危险因素，血清25（OH）D（ β=-0.192，95% CI=0.715~0.952， P=0.008）是高龄GDM孕妇发生OP的独立保护因素。根据Logistic多因素分析结果建立回归模型Logit（P）=1.425+1.074×（X3）-0.192×（X4）+1.306×（X5）， ROC分析结果显示，回归模型判断高龄GDM孕妇发生OP的准确性较高（AUC=0.821， P<0.001）。 结论:血清FABP4、25（OH）D及Visfatin与高龄GDM孕妇伴发OP相关，基于三者检测建立的回归模型对判断OP有较高准确性。

abstractsObjective:To study the predictive value of serum fatty acid binding protein 4 (FABP4), serum 25 hydroxyvitamin D [25 (OH) D] and serum visfatin in judging the occurrence of osteoporosis (OP) in elderly pregnant women with diabetes mellitus (GDM) .Methods:120 elderly pregnant women with GDM admitted in Qingdao Municipal Hospital East Branch from May. 2021 to May. 2024 were selected, 16 cases of OP occurred during pregnancy, which were as the observation group, and 104 cases did not occur, which were as the control group. The serum levels of FABP4, 25 (OH) D and Visfatin between the two groups of patients were compared, a Logistic multiple factor model was used to analyze the related factors of OP in elderly GDM pregnant women, a risk prediction regression model was established, and the judgment value of each factor and model were analyzed.Results:There were 16 cases who developed OP among the 120 elderly pregnant women with GDM, the incidence rate was 13.33%. The Logistic multivariate analysis showed that the serum FABP4 ( β=1.074, 95% CI=1.675-5.111, P< 0.001) and serum Visfatin ( β=1.306, 95% CI=2.156-6.322, P<0.001) were independent risk factors for OP in elderly GDM pregnant women, while serum 25 (OH) D ( β=-0.192, 95% CI=0.715-0.952, P=0.008) was independent protective factor for OP in elderly GDM pregnant women. A regression model Logit (P) =1.425+1.074× (X3) -0.192× (X4) +1.306× (X5) was established, which based on the results of logistic multivariate analysis. The ROC analysis results showed that the regression model had a higher accuracy in determining the occurrence of OP in elderly GDM pregnant women ( AUC=0.821, P<0.001) . Conclusions:The serum FABP4, 25 (OH) D, and Visfatin are associated with OP in elderly GDM pregnant women. The regression model established, which based on the detection of these three factors has high accuracy in determining OP.