7336例孕妇羊水甲胎蛋白检测结果分析及临床应用评价  

Analysis and clinical application evaluation of amniotic fluid AFP in 7336 gravida

作　　者：林飞[1] 郑海洋[1] 徐钰琪 韦升开 俸诗瀚[1] 阙婷[1] 陈少科[1] 

机构地区：[1]广西壮族自治区妇幼保健院遗传代谢中心实验室,广西南宁530000

出　　处：《中国计划生育和妇产科》2015年第10期52-56,共5页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的 建立各孕周羊水甲型胎儿球蛋白（amniotic fluid AFP,AFAFP）的中位数值,用于胎儿神经管缺损（neural tube defects,NTDs）的监测与诊断,并探讨AFAFP检测的临床价值。方法 2013~2014年广西壮族自治区妇幼保健院采用酶联免疫法对具有羊膜腔穿刺指征的7 336例孕妇进行AFAFP定量检测,筛查阳性者行彩色多普勒超声进行诊断。结果 AFAFP值随着胎儿的生长及孕期的延长逐渐降低,Ln（AFAFP值）与孕周呈线性负相关,数学方程式为Ln（AFAFP值）=-0.17×孕周＋14.29（R-squared=0.9244）;孕16~23周AFAFP 2.5 MOM值（即cutoff值）依次为42 211.88 ng/m L、35 634.28 ng/m L、25 562.80ng/m L、25 394.18 ng/m L、21 437.18 ng/m L、18 096.75 ng/m L、15 276.85 ng/m L、12 896.35 ng/m L;对临床诊断无脑畸形、心脏膨出、脑膨出、脐膨出、死胎检出率高;同一孕周孕妇的AFAFP浓度不随年龄的增大而升高。结论 本研究建立了AFAFP值与孕周的数学方程式及各孕周的中位数值。该AFAFP检测项目用于评价胎儿的安全状态,同时结合彩色多普勒超声检测等其它的临床指标进行综合分析,可早发现、早诊断,预防重大畸形胎儿出生,对于提高筛查的准确度与灵敏度更具意义。Objective To establish the median value of amniotic fluid AFP （AFAFP） in each gestational age, which was used for monitoring and diagnosis of fetal neural tube defects （ NTDs）, and to discuss the clinical value of AFAFP test. Methods ELISA was used in quantitive test of AFAFP in 7 336 gravida in Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Regionfrom 2013 to 2014, subjects with positive result were diagnosed by the color doppler ultrasound. Results AFAFP level went down as fetus grown and gestation prolonged, Ln（AFAFP） and gestation was negative correlated, mathematical equation was Ln（ AFAFP level） = -0. 17 ＊ gestation ＋ 14. 29 （ R - squared = 0. 9244）. Cut - off value of AFAFP in 16 - 23 gestation were 42211.88 ng/mL, 35634. 28 ng/mL, 25 562. 80 ng/mL, 25 394. 18 ng/mL, 21 437.18 ng/mL, 18 096. 75 ng/mL, 15 276. 85 ng/mL, 12 896. 35 ng/ mL respectively. The detection rate was high in some particular clinical diagnosis such as anencephaly, heart bulging, eneephaloeele, acromphalus, stillbirth. The concentration of AFAFP did not increased with the increment of gravida age. Conclusion The study established the mathematical equation of AFAFP value and gestational age, and the median value of each gestational age. The AFAFP testing program could be used to evaluate the safety of the fetus, combing with color doppler ultrasonic testing and other comprehensive analysis of clinical indicators, it？ could be use to discovery, diagnose and prevent the birth of the major malformation fetus in early pregnant, which was important to the improvement of the accuracy and sensitivity of the screening.

关 键 词：羊水甲胎蛋白 酶联免疫法 神经管缺损 

分 类 号：R715.5[医药卫生—妇产科学]