Relationship Between TLR4/MyD88 Signaling Pathway Related Proteins and Postpartum Abnormal Glucose Metabolism in Patients with Gestational Diabetes Mellitus

HUANG Caixia; ZHANG Yan; HU Qing

doi:10.3969/j.issn.1004-437X.2025.23.021

Abstract：Objective To investigate the relationship between TLR4/MyD88 signaling pathway related proteins and abnormal postpartum glucose metabolism in patients with gestational diabetes mellitus.Methods A total of 80 patients with gestational diabetes mellitus(GDM)who were treated and delivered in Xuchang People's Hospital from January 2020 to January 2023 were selected as the research objects.All patients were reexamined in the outpatient department 3 months after delivery.According to the glucose metabolism,they were divided into normal glucose metabolism group(46 cases)and abnormal glucose metabolism group(34 cases).Polymerase chain reaction(PCR)fluorescence quantitative analysis was used to detect Toll-like receptor 4(TLR4)and myeloid differentiation factor 88(MyD88)mRNA in peripheral blood of all subjects.The general clinical data of patients and the relative expression of TLR4 mRNA and MyD88 mRNA in peripheral blood were collected and compared.Pearson correlation analysis was used to analyze the correlation between the relative expression of TLR4 mRNA and MyD88 mRNA in peripheral blood and glucose and lipid metabolism indexes[glycosylated hemoglobin(HbA1c),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)].Multivariate logistic regression was used to analyze the independent risk factors of postpartum abnormal glucose metabolism in GDM patients.The receiver operating characteristic(ROC)curve was used to analyze the relative expression of TLR4 mRNA and MyD88 mRNA in peripheral blood to predict the efficacy of abnormal postpartum glucose metabolism in GDM patients.Results Pearson correlation analysis showed that the relative expression of TLR4 and MyD88 mRNA in peripheral blood was positively correlated with HbA1c,TG and LDL-C levels(P＜0.05).The relative expression levels of family history of diabetes,pre-pregnancy BMI,TLR4 mRNA and MyD88 mRNA in the abnormal glucose metabolism group were higher than those in the normal glucose metabolism group(P＜0.05).Family history of diabetes,high BMI during pregnancy,and increased relative expression of TLR4 mRNA and MyD88 mRNA in peripheral blood were independent risk factors for abnormal glucose metabolism in GDM patients(P＜0.05).The area under the curve(AUC)of TLR4 mRNA and MyD88 mRNA in peripheral blood combined with the prediction of abnormal postpartum glucose metabolism in GDM patients was 0.979,the specificity was 0.913,and the sensitivity was 0.971.Conclusion The relative expression of TLR4 mRNA and MyD88 mRNA in peripheral blood of patients with gestational diabetes mellitus and postpartum abnormal glucose metabolism can provide a reference for early prediction of postpartum metabolic abnormalities in GDM patients.