早中孕整合筛查方案的临床应用价值分析  

Analysis on clinical application value of integrated screening program in early and middle pregnancy

作　　者：范向群[1] 郑琳[1] 王梅英[1] 林娜[1] 黄海龙[1] 徐两蒲[1] 林元[1] 

机构地区：[1]福建省妇幼保健院福建医科大学教学医院,福建福州350001

出　　处：《中国妇幼保健》2016年第6期1220-1222,共3页Maternal and Child Health Care of China

基　　金：福建省临床重点专科建设项目资助(闽财指20121589号);福建省科技厅重大专项资助项目(2013YZ0002-1);福建省卫计委中青年骨干人才培养资助项目(2013-ZQN-ZD-6)

摘　　要：目的比较早中孕整合筛查方案与中孕期三联筛查方案的临床效果,探讨早中孕整合筛查方案的临床价值。方法应用时间分辨荧光免疫方法 （DELFIA）检测早孕期母血清标志物妊娠相关蛋白A（PAPP-A）,中孕期母血清标志物甲胎蛋白（AFP）、游离β人绒毛膜促性腺激素（freeβ-hCG）和游离雌三醇（uE3）,分别采用中孕期三联筛查方案（AFP、freeβ-hCG和uE3）和早中孕整合筛查方案（早孕期PAPP-A、中孕期AFP、freeβ-hCG和uE3）,利用lifecycle4.0风险分析统计软件计算胎儿发生的风险率,对两种方案的效果进行比较分析。结果 3 598例中孕期筛查高风险孕妇193例均行羊水产前诊断,其中3例孕妇诊断为21-三体综合征;另外3 405例孕妇中孕期筛查低风险孕妇均有产后随访,其中1例孕妇21-三体综合征漏筛。应用中孕期三联筛查方案检出21-三体综合征真阳性3例,漏筛1例;应用早中孕整合筛查方案检出21-三体综合征真阳性4例。共检出21-三体综合征高风险190例,阳性率为5.28%（190/3 598）,应用早中孕整合筛查方案检出21-三体综合征高风险99例,阳性率为2.75%（99/3 598）。中孕期筛查和早中孕整合筛查两种方法,差异有显著意义（χ^2=1 130.15,P〈0.001）。共检出18-三体高风险8例,阳性率为0.22%（8/3598）,应用早中孕整合筛查方案检出18-三体高风险5例,阳性率为0.14%（5/3 598）。中孕期筛查和早中孕整合筛查两种方法比较,差异有显著意义（P〈0.01）。结论应用早中孕整合筛查方案能显著降低假阳性率,对真阳性标本的筛查,整合筛查方案的效能也好于中孕筛查方案。Objective To compare the clinical effects of integrated screening program in early and middle pregnancy and triple screening program in middle pregnancy,explore the clinical value of integrated screening program in early and middle pregnancy. Methods Dissociation enhanced lauthanide fluoroimmunoassay（ DELFIA） was used to detect pregnancy-associated plasma protein（ PAPP-A） in early pregnancy,alpha- fetoprotein（ AFP）,free β- human chorionic gonadotropin（ free β- hCG）,and unconjugated estriol（ uE3） in middle pregnancy. Triple screening program in middle pregnancy（ AFP,free β-hCG,and uE3） and integrated screening program in early and middle pregnancy（ PAPP-A in early pregnancy,AFP,free β-h CG,and uE3 in middle pregnancy） were applied. Lifecycle 4. 0 software was used to calculate fetal risk rate. The effects of two programs were compared and analyzed. Results Among 3 598 specimens,DS positive rates of triple screening program and integrated screening program were 5. 28% and 2. 75%,respectively,there was statistically significant difference between the two programs（ χ^2= 1 130. 148,P〈0. 001）; ES positive rates of triple screening program and integrated screening program were 0. 22% and 0. 14%,there was statistically significant difference between the two programs（ P 〈0. 001）. Among 3 598 specimens,four children were diagnosed as positive trisomy 21 syndrome by integrated screening program,but there was one case of missed diagnosis by triple screening program. Conclusion Integrated screening program in early and middle pregnancy can significantly reduce the false positive rate,the efficiency is better than triple screening program in middle pregnancy in screening of true positive specimens.

关 键 词：早中孕整合筛查 中孕期产前筛查 21-三体综合征 18-三体综合征 

分 类 号：R715.5[医药卫生—妇产科学]