摘要
目的通过对比抑制素A单独或加入到传统三联21-三体综合征筛查前后检测结果的差异,评估抑制素A在孕中期21-三体综合征筛查中的作用,以建立一种简便、准确,且更加优化的孕期唐筛方案。方法采集18例21-三体综合征孕妇(病例组)与90例胎儿正常孕妇(对照组)稳态浓度的血浆样品行病例对照研究,利用全自动微粒子化学发光法检测抑制素A、AFP、u E_3和β-h CG含量,通过体重和孕周等校正后,用Ssdw Lab 5软件计算21-三体综合征风险值,并对检测结果进行统计分析。结果抑制素A(Mo M)在对照组和病例组孕妇中均符合对数正态分布;绘制各组抑制素A(Mo M)频数分布图,结果相比对照组,病例组孕妇的血清抑制素A水平显著抬高(1.13±0.47 Mo M vs 2.49±1.51 Mo M,P<0.05),中位Mo M分别为1.00 Mo M和2.18 Mo M,描记曲线整体右移。在1%、3%和5%的假阳性率时,抑制素A单变量的检出率分别为36%、50%和60%,与β-h CG单变量的检出率相当,而优于传统三联法中的另外两个血清标志物AFP和u E_3,数据间比较差异有统计学意义(P<0.05)。以抑制素A的检测数据为y,AFP、u E_3和β-h CG含量为x进行Passing-Bablock线性回归,发现抑制素A与β-h CG间呈正相关,相关系数为0.34,相关性有统计学意义(P<0.05),而与AFP和u E_3的相关性差异均无统计学意义(P>0.05)。传统三联筛查的ROC曲线下面积(ROC-AUC)为0.93,联合抑制素A后的四联筛查ROC曲线下面积为0.95;在5%假阳性率时,三联法和四联法的诊断敏感度分别为71%和78%,两种方案筛查效能差异具有统计学意义(P<0.05)。结论抑制素A是孕中期21-三体综合征筛查的最佳血清标志物之一,联合AFP、β-h CG和u E_3后的四联法较传统三联筛查有更好的检测性能,建议推广入临床常规使用。
Objective To determine the second trimester Down syndrome screening performance of maternal serum inhihin A, both alone and in combination with conventional triple serum markers. Methods For eighteen cases of maternal serum samples from Down syndrome pregnancies, ninety serum samples from normal pregnant women were matched. Content of inhibin A, alpha - fetoprotein （AFP）, unconjugated estriol （uE3 ） and human chorionic gonadotropin （β-hCG） were measured using automatic chemiluminescent methods. Data were adjusted by maternal weight and gestational age and risk of Down syndrome was calculated by SsdwLab 5 software. Results Inhibin A（MoM） levels of maternal serum in both control and case group are approximate log Gaussian. Compared to the control group, inhibin A concentration of the case group taken on frequency distribution graph were elevated significantly （1.13 ± 0.47 MoM vs 2.49 ± 1.51 MoM, P 〈 0.05 ） ,with median MoM 1.00 and 2.18, respectively. Besides, the distribution curve of inhibin A in Down syn- drome pregnancies was shifted to the right dramatically. At the false positive rates of 1% , 3% and 5% , detection rates of inhibin A were 36% , 50% and 60% , which were as good as β - hCG and better than AFP or uE3. Passing - Bablock regression showed a clear linear positive correlation between inhibin A and β - hCG, with a correlation coefficient r of 0. 34 （ P 〈 0.05 ） , while there showed no significant correlation between inhibin A and AFP or uE3. Area under the ROC curve （ ROC - AUC） for triple and quadruple screening was 0.93 and 0.95. At the false positive rate of 5% , the sensitivity of triple and quadruple screening was 71% and 78% , respectively. Conclusion Inhibin A is one of the best serum screening markers for Down syndrome in second trimester and quadruple screening consists of inhibin A, AFP, β -hCG and uE3 performed outstandingly better than traditional triple screening, so it is beneficial to recommend quad- ruple screening as a new scheme for clinical prenatal prediction of Down syndrome.
出处
《医学研究杂志》
2016年第5期134-137,共4页
Journal of Medical Research
