بررسی مقایسه ‏ای سطح سرمی و ادراری کورتیزول در دیابت بارداری و زنان باردار سالم

نوع مقاله: اصیل پژوهشی

نویسندگان

1 کارشناس ارشد بیوشیمی بالینی، واحد توسعه تحقیقات بالینی بیمارستان امام خمینی (ره)، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران.

2 دکترای بیوشیمی بالینی، بخش بیولوژیک دانشکده علوم، دانشگاه آزاد اسلامی، واحد اهر، اهر

3 متخصص داخلی، واحد توسعه تحقیقات بالینی بیمارستان امام خمینی (ره)، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران.

4 کارشناس ارشد اپیدمیولوژی، واحد توسعه تحقیقات بالینی بیمارستان امام خمینی (ره)، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران.

5 دانشجوی دکتری اپیدمیولوژی، واحد توسعه تحقیقات بالینی بیمارستان امام خمینی (ره)، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران.

چکیده

مقدمه: دیابت بارداری تحت عنوان عدم تحمل نسبت به کربوهیدرات با شدت‏ های متفاوت که اولین بار در زمان بارداری تشخیص داده شده یا بروز کرده است، تعریف می‌شود. بارداری به ‏عنوان شرایط استرس ‏زا، باعث افزایش ترشح کورتیزول می‏شود لذا با توجه به رابطه هورمون کورتیزول با دیابت بارداری، مطالعه حاضر با هدف بررسی و مقایسه‌ سطح کورتیزول سرم و ادرار در مادران باردار سالم و مادران مبتلا به دیابت بارداری انجام شد.
روش‌ کار: این مطالعه ‏مقطعی در سال 1392 بر روی 42 زن مبتلا به دیابت بارداری و 42 زن باردار سالم که به مرکز دیابت شهر کرمانشاه مراجعه کرده بودند، انجام شد. در هفته‏ 24 بارداری، نمونه‏ ادرار 24 ساعته و خون غیر ناشتا جهت بررسی سطح کورتیزول تهیه شد. تجزیه و تحلیل داده‏ها با استفاده از نرم افزار آماری SPSS (نسخه‏ 16) و آزمون‌های تی مستقل، همبستگی پیرسون، آنالیز کواریانس چند متغیره و من ویتنی انجام شد. میزان p کمتر از 05/0 معنی دار در نظر گرفته شد.
یافته ‌ها: بر اساس آزمون آنالیز کواریانس چند متغیره، بین سطح سرمی و ادراری کورتیزول در دو گروه مبتلا به دیابت بارداری و باردار سالم تفاوت معنی داری وجود داشت (001/0>p). در بررسی سطح زیر منحنی راک برای کورتیزول سرم 855/0 و برای کورتیزول ادرار 866/0 به ‏دست آمد و جهت تشخیص دیابت بارداری، حساسیت کورتیزول سرم 5/79% و ویژگی آن 9/82% و حساسیت کورتیزول ادرار 6/84% و ویژگی آن 2/90% به دست آمد.
نتیجه‏گیری: سطح سرمی و ادراری کورتیزول در زنان مبتلا به دیابت بارداری در مقایسه با زنان باردار سالم به طور معنی داری بیشتر است. شاید در آینده بتوان از این معیارها به عنوان معیار شناسایی دیابت بارداری استفاده کرد. سطح کورتیزول ادراری با حساسیت و ویژگی بالاتر و روش غیر تهاجمی ‏تر نسبت به کورتیزول سرم ارجح ‏تر است.

کلیدواژه‌ها


عنوان مقاله [English]

Comparison of serum and urinary cortisol levels in women with gestational diabetes and healthy pregnant women

نویسندگان [English]

  • Mina Azarmy 1
  • Aliakbar Abolfathi 2
  • Touraj Ahmadi Jouybari 3
  • Mari Ataee 3
  • Bahareh Lotfi 4
  • Abbas Aghaei 5
1 M.Sc. of Clinical Biochemistry, Clinical Research Development Center, Imam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
2 PhD of Clinical Biochemistry, Department of Biologic, School of Science,Islamic Azad University of Ahar, Aahr, Iran
3 Internist, Clinical Research Development Center, Imam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
4 M.Sc. of Epidemiology, Clinical Research Development Center, Imam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
5 PhD student of Epidemiology, Clinical Research Development Center, Imam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
چکیده [English]

Introduction: Gestational diabetes is defined as carbohydrate intolerance with different severity which is first diagnosed or occurred during pregnancy. Pregnancy as a stressful situation increases the secretion of cortisol. Therefore, considering the relation between cortisol hormone and gestational diabetes, this study was performed with the aim to evaluate and compare serum and urinary cortisol levels in healthy pregnant women and women with gestational diabetes.
Methods: This cross-sectional study was performed on 42 women with Gestational Diabetes Mellitus and 42 healthy pregnant women who had referred to Kermanshah diabetic center in 2013. In 24th gestational weeks, 24-h urine sample and no fasting blood sample were provided to assess cortisol level. Data was analyzed using SPSS software (version 16) and statistical tests of independent-t, Pearson correlation, multivariate covariance analysis, and Mann-Whitney. PResults: According to multivariate analysis of covariance analysis, there was significant difference between serum and urinary cortisol levels in two groups of healthy pregnant women and women with gestational diabetes (P<0.001). In the evaluation of under the ROC curve, 0.855 was obtained for serum cortisol and 0.866 for urinary cortisol, and to diagnose the gestational diabetes, sensitivity and specificity of serum cortisol were obtained 79.5% and 82.9%, and sensitivity and specificity of urine cortisol 84.6 % and 90.2%, respectively.
Conclusion: Serum and urinary cortisol levels is significantly higher in women with gestational diabetes compared to healthy pregnant women. Perhaps with performing studies, these criteria can be used as a criterion to diagnose gestational diabetes. Urinary cortisol level with higher sensitivity and specificity and more non-invasive method is preferred to serum cortisol test.         

کلیدواژه‌ها [English]

  • Cortisol
  • Gestational diabetes
  • sensitivity
  • specificity
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