摘要
目的探讨孕中期孕妇血清学筛查唐氏综合征高风险与不良妊娠结局发生的关系，评价其对不良妊娠结局的预测价值。方法收集2009年1月至2011年1月在北京协和医院进行孕中期唐氏综合征血清学三联（甲胎蛋白＋游离p—hCG＋游离雌三醇）筛查并有妊娠结局的孕妇，血清学筛查的唐氏综合征高风险值为≥1／270，对唐氏综合征筛查出的高危孕妇（高危组）和低危孕妇（低危组）的一般情况、妊娠并发症及合并症进行分析；并以35岁为界值，分析〈35岁和≥35岁孕妇的不良妊娠结局发生率。结果（1）共1935例孕中期孕妇纳入本研究，其中低危组1784例，高危组151例。两组孕妇体质量、分娩孕周比较，差异无统计学意义（P〉0．05）；两组孕妇年龄比较，差异有统计学意义（P〈0．01）。（2）1935例孕妇中发生各种妊娠并发症及合并症791例，其中高危组孕妇妊娠期糖尿病（GDM）、新生儿窒息、小于胎龄儿（SGA）发生率分别为13．9％（21／151）、4．0％（6／151）、4．6％（7／151），高于低危组的8．4％（149／1784）、1．0％（17／1784）、1．6％（29／1784），两组比较，差异有统计学意义（P〈0．05）。两组孕妇妊娠期高血压疾病、早产、羊水过少、前置胎盘、胎盘早剥、巨大儿等不良妊娠结局发生率比较，差异无统计学意义（P〉0．05）。（3）1935例孕妇中，年龄〈35岁1705例，GDM、妊娠期高血压疾病、早产的发生率分别为7．6％（129／1705）、2．5％（43／1705）、3．6％（61／1705）；年龄≥35岁230例，GDM、妊娠期高血压疾病、早产的发生率分别为17．8％（41／230）、5．2％（12／230）、6．5％（15／230），两者上述并发症发生率比较，差异均有统计学意义（P〈0．05）。年龄〈35岁时，高危孕妇GDM、新生儿窒息及SGA的发生率[分别为12．3％（14／114）、4．4％（5／114）及5．3％（6／114）]高于低危孕妇[分别为7．2％（115／1591）、0．9％（14／1591）及1．6％（26／1591）]，差异均有统计学意义（P〈0．05）；年龄≥35岁时，高危孕妇GDM、新生儿窒息及SGA的发生率[分别为18．9％（7／37）、2．7％（1／37）及2．7％（1／37）]略高于低危孕妇[分别为17．6％（34／193）、1．6％（3／193）及1．6％（3／193）]，差异均无统计学意义（P〉0．05）。结论孕中期孕妇血清学筛查唐氏综合征高风险与不良妊娠结局发生有密切联系，高龄是唐氏综合征筛查高风险和不良妊娠结局发生的重要因素，年龄〈35岁的唐氏综合征筛查高风险孕妇也应引起重视。
Objective To investigate the the relationship of a high risk serum screen for Down syndrome in second trimester and adverse pregnancy outcomes, and to evaluate the predictive value for adverse pregnancy outcomes. Methods The tri-marker second trimester maternal serum screening for Down syndrome （alpha-fetoprotein, free beta-hCG and unconjugated estriol）was performed on the pregnant women at Peking Union Medical Hospital from January 2009 to January 2011. The cutoff valvue was 1/270. Pregnancy outcomes were followed up. The general condition and pregnancy complications of the pregnant women with high risk （high-risk group） were compared to that of the pregnant women with low risk （low-risk group）; and with 35 years old as a demarcation, the incidences of adverse pregnancy outcomes were calculated in the two groups. Results （ 1 ） A total of 1935 cases were collected. And 1784 cases were with low risk, and 151 cases were with high risk. The difference of weight and gestational age betweem the two groups was not statistically significant （ P 〉 0. 05 ） ; the difference of age between the two groups was statistically significant （ P 〈 0. 01 ） . （ 2 ） Pregnancy complications were found in 791 cases. In high-risk group, the incidences of gestational diaetes mellitus （ GDM, 13.9% ） , neonatal asphyxia （4. 0% ） and small for gestational age infant （ SGA, 4. 6% ） were higher than that in low-risk group （ 8.4% , 1.0% , 1.6% ） , the difference was statistically significant （ P 〈 0.05 ）. The incidences of gestational hypertension disease, premature labor, oligohydramnios, placenta previa, placenta abruption, fetal macrosomia in the two groups was not statistically different （P 〉 0. 05）. （3） In 1705 cases aged less than 35 years, 129 cases （7. 6% ） were GDM, 43 cases （2. 5% ） were gestational hypertension disease, 61 cases （3.9%） were premature labor; in 230 cases aged 35 years or more, 41 cases （17. 8% ） were GDM, 12 cases （5.2%） were gestational hypertension disease, 15 cases （6. 5% ） were premature labor, and the difference between the two groups was statistically significant （P 〈0. 05）. In 〈 35 years old group, the incidences of GDM, neonatal asphyxia and SGA （12. 3% , 4. 4% , 5.3% ） were higher in the high-risk group than that （7.2% , 0. 9%, 1.6% ） in the low-risk group, and the difference was statistically significant （P 〈0. 05）. In I〉35 years old group, the incidences of GDM, neonatal asphyxia and SGA （ 18.9%, 2. 7%, 2. 7% ） were slightly higher in the high-risk group than that （17.6%, 1.6%, 1.6%） in the low-risk group, the difference between the two groups was not statistically significant （ P 〉 0. 05 ）. Conclusions The present study revealed apparent increase in the adverse pregnancy outcomes in women with a high risk of Down syndrome screening test. Advanced age is the most important risk factor for a high risk of Down syndrome screening test and adverse pregnancy outcomes. More attention should be attached to the patients whose age were 〈 35 years old and with a high risk of Down syndrome screening test.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2012年第6期427-430,共4页
Chinese Journal of Obstetrics and Gynecology
关键词
唐氏综合征
妊娠中期
妊娠结局
Down syndrome
Pregnancy trimester, second
Pregnancy outcome
