唐氏筛查对妊娠期肝内胆汁淤积症的预测价值分析  

Predictive Value of Down’s Screening in Intrahepatic Cholestasis of Pregnancy

作　　者：杨琴[1] 蒋燕[2] YANG Qin;JIANG Yan(Department of Laboratory Medicine,Mianyang People's Hospital,Mianyang 621000,Sichuan,China;Prenatal Diagnosis Center,Mianyang People's Hospital,Mianyang 621000,Sichuan,China)

机构地区：[1]绵阳市人民医院检验科,四川绵阳621000 [2]绵阳市人民医院产前诊断中心,四川绵阳621000

出　　处：《中国实验诊断学》2022年第5期696-699,共4页Chinese Journal of Laboratory Diagnosis

基　　金：四川省绵阳市卫健委科研(201846)。

摘　　要：目的 探讨孕中期唐氏筛查血清学指标和妊娠期肝内胆汁淤积症(ICP)的关系,分析游离人绒毛膜促性腺激素β亚基(f-β-HCG)、甲胎蛋白(AFP)、游离雌三醇(uE3)和抑制素A(Inh-A)4种因子独立及联合对ICP的预判价值。方法 对2019年住院孕妇进行回顾性分析,出院诊断ICP为研究组(280例,其中轻度255例,重度25例),同期随机选取出院诊断为头位顺产的单胎孕妇为正常对照组(210例),对妊娠中期f-β-HCG、uE3、AFP和Inh-A的水平进行统计比较,应用工作者曲线(ROC曲线下面积AUC)、约登指数和二元Logistic回归分析评判指标对预判ICP及其分度的价值。结果 研究组f-β-HCG、uE3和Inh-A水平高于正常对照组(P<0.05);采用f-β-HCG、uE3和Inh-A单指标独立诊断重度ICP的敏感性、特异性和AUC面积均高于轻度ICP,联合诊断的敏感性和AUC面积均高于单指标分析,且联合分析在诊断重度ICP中有较高价值,敏感度96.0%,AUC面积为0.822。经二元Logistic回归分析,f-β-HCG、uE3升高是导致ICP发生的危险因素(P<0.05),且随着其水平升高,发生概率上升,对预测重度ICP的价值更为明显。结论 本文挖掘了孕中期唐氏筛查血清学指标除用于筛查21—三体、18—三体和神经管缺陷外,对其他临床疾病有一定诊断价值,f-β-HCG、uE3和Inh-A筛查指标能早期预测ICP的发生,其中f-β-HCG、uE3是引起ICP的危险因素,预测重度ICP有较高价值。Objective To explore the relationship between the serum index levels of Down’s screening in the second trimester and intrahepatic cholestasis of pregnancy(ICP),and to analyze the value of free human chorionic gonadotropinβsubunit(f-β-HCG),alpha-fetoprotein(AFP),free estriol(uE3)and inhibin A(Inh-A)alone or in combination to the prediction of ICP.Methods It retrospectively analyzed the pregnant women in 2019was carried out.The pregnant women discharge diagnosis with ICP were selected as the study group(280cases,including 255mild cases and 25severe cases),while the singleton pregnant women discharge diagnosis with spontaneous vertex delivery as the normal control group(210cases).The level of f-β-HCG,uE3,AFP and Inh-A in pregnant women in the second trimester of pregnancy were statistically compared,and Worker curve(AUC under ROC curve),Youden index and binary Logistic regression were used to evaluate the value of Down’s screening serological indicators to the prediction of ICP and its grading.Results The levels of f-β-HCG,uE3,and Inh-A in the study group were higher than those in the control group and the differences were of statistical significance(P<0.05).When single indicators of f-β-HCG,uE3and Inh-A were used for ICP diagnosis,the sensitivity,specificity,and AUC area of independent diagnosis of severe ICP were higher than that of mild ICP.The sensitivity and AUC area of combined diagnosis with three indicators of Down’s screening were higher than those with single indicator,and combined analysis had significantly higher value in the diagnosis of severe ICP,with a sensitivity of 96.0%,and an AUC area of 0.822.Through binary logistic regression analysis,it found out that the increase of f-β-HCG and uE3were the risk factors for ICP(P<0.05),and as their levels increased,the occurrence of ICP increased,which was more valuable to the prediction of severe ICP.Conclusion It finds out that the Down’s screening serum indexes in the second trimester of pregnancy,in addition to the screening of 21-trisomy,18-

关 键 词：f-β-HCG AFP UE3 Inh-A 妊娠期肝内胆汁淤积症 

分 类 号：R575.6[医药卫生—消化系统]