南京地区孕早期产前筛查指标中位数建立和临床意义探讨  

Establishment of the median value of soft-marker in first-trimester prenatal screening and investigation of its clinical significance of Nanjing area

作　　者：蒋涛[1] 孙云[1] 张晓娟[1] 查文[1] 徐倩君[1] 张燕[1] 张瑾[1] 黄美莲[1] 许争峰[1] 

机构地区：[1]南京医科大学附属南京妇幼保健院产前诊断中心,江苏南京210004

出　　处：《南京医科大学学报（自然科学版）》2011年第1期71-75,共5页Journal of Nanjing Medical University(Natural Sciences)

基　　金：南京市医学科技发展重点项目(ZKX06011);南京市医学科技发展重点项目(ZKX08001)

摘　　要：目的:建立南京地区孕早期产前筛查血清游离β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-HCG)、妊娠相关蛋白A(pregnancy-associated plasma protein A,PAPP-A)及胎儿颈项皮肤透明层厚度(nuchal translucency thickness,NT)等指标的中位数值,探讨孕早期筛查切割值的制定和筛查指标的临床意义。方法:采用时间分辨免疫荧光(time-resolved fluoroim-munoassay,TRFIA)技术对1 684例妊娠8～13+6周孕妇血清游离β-HCG和PAPP-A浓度进行测定,并在其妊娠11～13+6周通过超声技术测定胎儿NT值,随访已分娩孕妇的妊娠结局。结果:①孕妇不同孕周血清游离β-HCG中位数平均水平比软件内嵌高32%,而PAPP-A除8周外均接近于软件内嵌,NT值则低于软件内嵌15%;②当筛查阳性率为5%时,21-三体高风险的切割值约为1∶550,共检出4例染色体异常;③不良妊娠结局者孕早期筛查单指标中血清PAPP-A中位数的倍数值(multiples of the medi-an,MOM值)显著低于正常结局者,NT值则显著高于正常结局者。结论:①不同地区血清和超声指标中位数的筛查切割值制定标准可能存在差异,有必要进一步深入探讨应用国外软件作内嵌参数的适用性;②孕早期产前筛查单指标MOM值对妊娠结局的判定有重要意义,并有助于检出其他染色体异常。Objective：To establish the evaluation of the median values for serum free β-human chorionic gonadotropin（β-HCG）,pregnancy-associated plasma protein A（PAPP-A）and fetal nuchal translucency thickness（NT）in first-trimester prenatal screening in Nanjing region and investigate the standard program of the cutoff value for clinical soft-marker and its significance in prenatal diag-nosis.Methods： The concentrations of β-HCG and PAPP-A in 1 684 gravidas with pregnancy of from 8 to 13＋6 weeks were measured by time-resolved fluoroimmunoassay（TRFIA）,and fetal NT value in their gestation from 11 to 13＋6 weeks was determined by ultra-sound scanning.Then the pregnancy outcomes of gravidas were followed up.Results： ① The median values ofβ-HCG in different gestigational week were 32% higher than their embedded parameters of software,those of PAPP-A were close to their embedded pa-rameters in different gestigational week except in the 8th week of pregnancy,and those of NT values were 15% less than their embed-ded parameters;② when the positive rate of prenatal screening was 5%,the cutoff value of high risk in 21-trisome（Down’s Syn-drome）was about 1∶550,and 4 cases with chromosome abnormalities were detected;③ The multiples of the median（MOM）values of serum PAPP-A with adverse pregnancy outcome in first-trimester prenatal screening were significantly lower than those with normal pregnancy outcome,and NT values were markedly higher than those with the normal pregnancy outcome.Conclusion： The standard cutoff values of the median soft-markers in serum and ultrasound scanning may be different in diverse regions,thus it is necessary to further investigate its applicability of the embedded parameters with foreign software;What′s more the MOM value of single soft-mark-er in first-trimester prenatal screening is important on the pregnancy outcome assessment,and it is benefit to detect other chromosomal abnormalities.

关 键 词：产前筛查 孕早期 指标 

分 类 号：R714.12[医药卫生—妇产科学]