抑制素A在妊娠中期唐氏综合征筛查中的价值  

Efficiency of quadruple test including inhibin-A in second-trimester screening for Down syndrome

作　　者：满婷婷[1] 廖灿[1] 韩瑾[1] 李东至[1] 白雪[1] 林琳[1] 孙茜[1] 

机构地区：[1]广州医学院附属广州市妇女儿童医疗中心产前诊断中心,510623

出　　处：《中华围产医学杂志》2012年第5期273-277,共5页Chinese Journal of Perinatal Medicine

基　　金：基金项目：“十一五”国家科技支撑计划（2006BA105A05）

摘　　要：目的建立广东地区正常妊娠人群血清抑制素A在妊娠15～20＋6周的参考值范围，评估抑制素A在四联唐氏综合征筛查中的价值。方法选择2008年3月至2010年12月在广州市妇女儿童医疗中心接受妊娠中期三联唐氏综合征筛查的单胎妊娠孕妇2802例。采用酶联免疫化学发光分析法检测孕妇血清中抑制素A水平，将检测值转换为中位数的倍数（multiplesofthemedian，MoM），并根据母亲体重和孕周进行校正。采用SURUSS相关参数重新计算风险值并统计不同切割值水平的筛查效果。通过受试者工作特性曲线及曲线下面积评估单项和各标志物组合的筛查效果。结果（1）正常单胎孕妇（对照组，2790例）妊娠15～20＋6周时各孕周血清抑制素A浓度的中位数分别为286．60、267．10、249．10、243．40、242．30和256．60pg／ml，各孕周浓度相对稳定。12例胎儿为唐氏综合征的孕妇血清中抑制素A的MoM值及平均浓度均显著高于对照组[MoM值：2．82与1；平均浓度：（852．83±370．04）pg／ml与（293．28±149．46）pg／ml，差异有统计学意义（t=5．37，P〈0．05）]。（2）假阳性率为5．8％时，游离人绒毛膜促性腺激素-B、甲胎蛋白、未结合雌三醇和抑制素A组成的四联唐氏综合征筛查检出率为83．3％（10／12）；当检出率为83．3％时，妊娠中期四联唐氏综合征筛查的假阳性率（5．8％）较游离人绒毛膜促性腺激素-8、甲胎蛋白和未结合雌三醇组成的三联唐氏综合征筛查（7．7％）降低了1．9％。受试者工作特性曲线上，假阳性率为5．0％时，抑制素A、甲胎蛋白、游离人绒毛膜促性腺激素-B和未结合雌三醇的曲线下面积分别为63．7％、20．5％、46．1％和4．8％；传统三联和四联唐氏综合征筛查的曲线下相对面积分别为45．5％和63．1％。结论建立了广东地区正常妊娠人群血清抑制素A在妊娠15～20州周的�Objective To establish the reference value of inhibin-A in the serum of pregnant women with gestational age from 15 to 20＋6 weeks in Guangdong province, and assess the efficiency of inhibin-A and quadruple test in Down syndrome screening. Methods A total of 2802 singleton pregnancies receiving triple test screening in Guangzhou Women and Childrenrs Medical Center from March 2008 to December 2010 were included in this study. Inhibin-A was measured by automatic enzyme-linked immunosorbent chemiluminescence assay. The concentration of inhibin-A was expressed as multiples of the median （MoM）, and adjusted with maternal weight and gestational age. Parameters of SURUSS were used to recalculate the risk of Down syndrome. The efficacy of single marker and combination were evaluated by receiver operating characteristic curve and the area under the curve. Results （1） In normal singleton pregnancies, the median concentration of inhibin-A was 286.60, 267. 10, 249.10, 243.40, 242.30 and 256.60 pg/ml respectively for each week of gestational age from 15 to 20＋6 weeks. The distribution of inhibin-A in each gestational week was relativelystable. The mean concentration E（852. 83±370. 04） pg/ml] and MoM （2.82） of inhibin-A in twelve pregnant mothers with Down syndrome fetuses were significantly higher than those without E（293. 28±149. 46） pg/ml （t=5.37, P=0.05） and 1, respectively]. （2） The detection rate was 83.3% （10/12） by using the quadruple test including free human chorionic gonadotropin-13, alpha- fetoprotein, unconjugated estriol and inhibin-A at false positive rate of 5.8M; while when the detection rate of triple test including alpha-fetoprotein, free human chorionic gonadotropin-13 and unconjugated estriol was 83.3%, the false positive rate was 7.7%. When the false positive rate was set to 5.0%, the area under the curve of inhibin-A, alpha-fetoprotein, free human chorionic gonadotropin-β and unconjugated estriol was 63.7%, 20.5%, 46.1% and 4.8%, respectively, and the relative area u

关 键 词：妊娠中期 唐氏综合征 抑制素类 

分 类 号：R714.5[医药卫生—妇产科学]