孕16~27周母体血清AFP联合超声在胎儿神经管畸形筛查中的应用  

Application of Maternal Serum AFP Combined with Ultrasonography in the Screening of Fetal Neural Tube Defects at 16-27 Weeks of Gestation

作　　者：邓勇 古余萍 李丽发 冷俊 刘婷 DENG Yong;GU Yuping;LI Lifa;LENG Jun;LIU Ting(Yichun Yuanzhou Modern Hospital,Yichun 336000,China)

机构地区：[1]宜春袁州现代医院,江西宜春336000

出　　处：《中国医学创新》2023年第8期109-114,共6页Medical Innovation of China

基　　金：宜春市科技计划项目(2022ZDJH6312)。

摘　　要：目的:探讨孕中期母体血清甲胎蛋白(AFP)结合超声筛查胎儿神经管畸形的临床价值,为临床诊疗胎儿神经管畸形提供参考依据。方法:收集2019年1月-2022年1月于宜春袁州现代医院接受孕中期(孕16~27周)神经管畸形筛查的孕妇进行前瞻性研究,均行超声检查,同时检测母体血清AFP水平;筛查为神经管畸形胎儿进行引产后尸检或出生后跟踪随访证实,健康胎儿进行电话或门诊随访证实;以引产或出生后跟踪随访结果为“金标准”,分为阳性组和阴性组,比较两组母体血清AFP水平;分析超声检查结果及影像学表现,同时分析超声检查结果与血清AFP水平的关系,评价孕中期母体血清AFP结合超声筛查胎儿神经管畸形的价值。结果:本研究共筛查7694例孕妇,其中12例失访,最终7682例孕妇纳入本次研究。共有19例胎儿确诊为神经管畸形,占2.47‰(19/7682)。超声正确诊断胎儿神经管畸形为17例,其中无脑儿7例,露脑畸形1例,脑膨出1例,脊柱裂8例。阳性组血清AFP水平高于阴性组(P<0.05);点二列相关分析,超声检查阳性与母体血清AFP呈正相关(r=0.532,P=0.019);孕中期母体血清AFP结合超声筛查胎儿神经管畸形的曲线下面积(AUC)最大,为0.910,敏感度、特异度分别为89.50%、98.80%。结论:孕中期母体血清AFP结合超声在筛查孕中期胎儿神经管畸形筛查中具有一定的价值。Objective:To explore the clinical value of maternal serum alpha fetoprotein(AFP)combined with ultrasound screening for fetal neural tube defects in the second trimester of pregnancy,so as to provide reference for clinical diagnosis and treatment of fetal neural tube defects.Method:A prospective study was conducted on pregnant women who were screened for neural tube defects in the second trimester(16-27 weeks of gestation)in Yichun Yuanzhou Modern Hospital from January 2019 to January 2022.All of them underwent ultrasound examination,and the maternal serum AFP level was detected at the same time.The screening was confirmed by autopsy after induction of labor or follow-up after birth for fetuses with neural tube abnormalities,and confirmed by telephone or outpatient follow-up for healthy fetuses.The results of induction of labor or follow-up after birth were the"gold standard",the pregnant women were divided into positive group and negative group,and the maternal serum AFP levels of the two groups were compared.The results of ultrasound examination and imaging manifestations were analyzed.At the same time,the relationship between the results of ultrasound examination and serum AFP level was analyzed,the value of maternal serum AFP combined with ultrasound in screening fetal neural tube defects in the second trimester was analyzed.Result:A total of 7694 pregnant women were screened in this study,of which 12 were lost to follow-up.Finally,7682 pregnant women were included in this study.A total of 19 fetuses were diagnosed with neural tube defects,accounting for 2.47‰(19/7682).Ultrasound correctly diagnosed fetal neural tube malformation in 17 cases,including 7 cases of anencephaly,1 case of open brain malformation,1 case of encephalocele,and 8 cases of spina bifida.The maternal serum AFP level of positive group was higher than that of negative group(P<0.05).Point-biserial correlation analysis showed that the positive rate of ultrasonography was positively correlated with maternal serum AFP(r=0.532,P=0.019).The area

关 键 词：胎儿神经管畸形 甲胎蛋白 超声 孕中期 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]