摘要
目的研究中期孕妇血清中甲胎蛋白(AFP)、游离雌三醇(uE3)、游离人绒毛膜促性腺激素β-亚单位(β-hCG)水平的临床意义及影响因素分析。方法用全自动免疫发光分析仪检测5 308例14～20周孕妇血清AFP、uE3、游离β-hCG水平,对所测的AFP、uE3、游离β-hCG各项结果进行风险分析,唐氏综合征(DS)风险率1∶380属于高危,18-三体综合征(Trisomy 18)风险率1∶334属于高危,开放性脊柱裂(OSB)风险率1∶1 000属于高危。高危组建议行羊水穿刺或B超检查,全程随访5 308例孕妇的妊娠经过及妊娠结果。结果 5 308例中期孕妇中,唐氏筛查阳性共275例,占5.2%(275/5 308),随后进行羊水穿刺经染色体核型分析、B超或待分娩后进行随访,确诊11例,阳性确诊率为5.8%(16/275),而低危组中有3例,假阴性率为0.06%(3/5 033)。高危组主要分布在35岁以上,随着年龄增加,筛查的阳性率增高。35岁以上及35岁以下筛查阳性率分别为12.9%(174/1 345)和2.5%(101/3 963),两组比较差异有统计学意义(P<0.01),但两组间高危组中确诊阳性率差异无统计学意义(P>0.05)。高危、低危组间唐氏综合征发病率比较,两组差异有统计学意义(P<0.01)。结论中期孕妇血清中AFP、uE3、游离β-hCG指标联合检测是筛查唐氏综合征、18-三体综合征、开放性脊柱裂准确且无创伤性的方法,可作为较理想的产前检查模式,但有一定的假阳性率。为了减少假阳性,高危孕妇要及时进行羊水和B超检查。孕妇年龄与检出阳性率呈正相关。因此,建议在30岁前计划生育,减少或杜绝高危出生的缺陷患儿。
Objective To investigate the clinical significance and influencing factors of serum level of alpha fetoprotein（AFP）,free estriol（uE3） and free β-human chorionic gonadotropin（free β-hCG） in woman at intermediate stage of pregnancy.Methods Completely automatic immunity illumination analysis was performed for the detection of serum AFP,uE3 and free-β-HCG in 5 308 cases of woman at 14-20 week during pregnancy.The diagnostic criterion of high-risk was 1∶380 for Down＇s syndrome（DS）,1∶334 for Trisomy 18 and 1∶1 000 for open spina bifida（OSB）.Amniotic fluid puncture or ultrasound inspection were performed for high-risk group.Follow-up visit was carried out for all 5 308 cases of pregnant women during whole process of pregnancy.Results Among all subjects,5.2%（275/5 308） were positive for DS screening,among which 5.8%（16/275） were definitely diagnosed for DS by amniotic fluid puncture,ultrasound inspection or follow-up visit after parturition.In low-risk group,3 cases were definitely diagnosed for DS with the false negative rate of 0.06%（3/5 033）.Subjects in high-risk group were mainly above 35 years old,and the positive rate of screening increased with the raise of age.There was significant difference of positive rate of screening between pregnant women more than 35 years old[12.9%（174/1 345）] and those less than 35 years old[2.5%（101/3 963）]（P0.01）,but there was no significant difference for high risk group of the tow age groups（P0.05）.The difference of incidence rate of DS during high-risk and low-risk group was significant（P0.01）.Conclusion Combined detection of serum AFP,uE3 and freeβ-hCG was ideal for the screening of DS,Trisomy 18 and OSB without traumatic occlusion,but with certain false positive rate.In order to reduce false positive rate,amniotic fluid puncture and ultrasound inspection should performed for pregnant women with high-risk factors.There was positive correlation between age of pregnant woman and positive rate of screening.Therefore,birth control should be carried out before 30 years old to reduce or avoid the brith of infants with defection.
出处
《国际检验医学杂志》
CAS
2011年第18期2059-2060,共2页
International Journal of Laboratory Medicine
