血清标记物检测在妊娠中期唐氏综合征产前筛查中的应用价值  

Value of serum markers in prenatal screening of Down syndrome in the second trimester of pregnancy

作　　者：张杉 何海丽 王斌[2] Shan Zhang;Haili He;Bin Wang(Department of Clinical Laboratory,Anyang Maternal and Child Health Hospital,Anyang 455000,China;Department of Reproductive Infertility,Anyang Maternal and Child Health Hospital,Anyang 455000,China)

机构地区：[1]河南省安阳市妇幼保健院检验科,455000 [2]河南省安阳市妇幼保健院生殖不孕症科,455000

出　　处：《中国实用医刊》2021年第21期70-73,共4页Chinese Journal of Practical Medicine

摘　　要：目的分析血清标记物检测在妊娠中期唐氏综合征产前筛查中的应用价值。方法抽取2018年2月至2020年7月安阳市妇幼保健院收治的妊娠中期进行唐氏综合征产前筛查的孕妇208例,检测其血清甲胎蛋白(AFP)、游离雌三醇(uE3)、人绒毛膜促性腺激素(HCG)、抑制素A水平,比较不同年龄孕妇高风险筛查和确诊结果,比较不同孕周、不同染色体异常胎儿的母体血清标记物检测水平,统计血清标记物四联检测结果和诊断效能。结果208例孕妇中,≥35岁者71例,<35岁者137例;≥35岁孕妇的高风险率为40.85%(29/71),羊膜穿刺率为62.07%(18/29),确诊率为19.72%(14/71),高于<35岁孕妇的17.52%(24/137)、33.33%(8/24)、1.46%(2/137),P<0.05。随着孕周的增加,AFP水平呈增高趋势,HCG水平呈降低趋势(P<0.05),不同孕周孕妇的抑制素A水平存在U型变化(P<0.05)。唐氏综合征孕妇AFP MOM值、HCG MOM值高于18-三体综合征孕妇(P<0.05)。血清标记物四联检测的敏感度为76.92%(10/13),特异度为92.82%(181/195),准确度为91.83%(191/208),阳性预测为41.67%(10/24),阴性预测值为98.37%(181/184)。结论妊娠中期采用血清标记物检测可预测胎儿染色体异常风险,血清AFP、uE3、HCG、抑制素A联合检测唐氏综合征敏感度、阳性预测值理想,可进一步提高产前筛查效果,为唐氏综合征临床诊断和早期干预提供信息支持。Objective To analyze the value of serum markers in prenatal screening of Down syndrome in the second trimester of pregnancy.Methods A total of 208 pregnant women who underwent prenatal screening of Down syndrome in Anyang Maternal and Child Health Hospital from February 2018 to July 2020 were selected.The levels of serum alpha-fetoprotein(AFP),unconjugated estriol(uE3),human chorionic gonadotrophin(HCG)and inhibitin A were measured.The results of high-risk screening and diagnosis of pregnant women of different ages were compared.The detection levels of maternal serum markers were compared among patients with different gestational ages and different chromosomal abnormalities.The results of triple detection and diagnostic efficiency of serum markers were analyzed.Results Among 208 pregnant women,71 cases were≥35 years old,and 137 cases were<35 years old;the high risk rate(40.85%,29/71),amniocentesis rate(62.07%,18/29)and diagnosis rate(19.72%,14/71)of pregnant women≥35 years old were higher than those of pregnant women<35 years old(17.52%,24/137;33.33%,8/24;1.46%,2/137),P<0.05.With the increase of gestational age,AFP level increased,while HCG level decreased(P<0.05).U-shaped changes in inhibitin A levels were observed in different gestational weeks(P<0.05).The values of AFP MOM and HCG MOM in Down syndrome were higher than those in 18 trisomy syndrome(P<0.05).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 76.92%(10/13),92.82%(181/195),91.83%(191/208),41.67%(10/24)and 98.37%(181/184),respectively.Conclusions The detection of serum markers in the second trimester can predict the risk of fetal chromosomal abnormalities.The sensitivity and positive predictive value of serum AFP,uE3,HCG and inhibitin A combined detection of Down syndrome are ideal,which can further improve the effect of prenatal screening,provide information support for clinical diagnosis and early intervention of Down syndrome.

关 键 词：唐氏综合征 妊娠中期 产前筛查 甲胎蛋白 游离雌三醇 人绒毛膜促性腺激素 

分 类 号：R714.5[医药卫生—妇产科学]