无锡地区孕中期孕妇血清AFP、free β-HCG、uE_3中位数标化及其应用
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摘要
目的对无锡地区孕中期单胎孕妇血清甲胎蛋白(AFP)、游离β人绒毛膜促性腺激素(freeβ-HCG)、游离雌三醇(uE_3)水平的中位数进行孕周、体质量标化,并分析其在21三体综合征(DS)、18三体综合征(ES)及神经管缺陷(NTD)风险评估中的应用效能。方法对无锡地区8 783名孕中期(孕15~20+6周)单胎孕妇进行血清AFP、freeβ-HCG、uE_3检测。应用Life Cycle4.0软件分析得到血清AFP、freeβ-HCG、uE_3水平的中位数,先后进行孕周、体质量标化调整,得到新的中位数。应用标化后的中位数进行DS、ES及NTD风险评估,以羊水核型分析结果和出生后结局为标准,比较标化前后血清学指标中位数的应用效能。结果无锡地区孕妇血清freeβ-HCG中位数较高,与未标化中位数(软件内置,来自高加索人群)相比,P均<0.01。标化中位数对DS、ES的筛查效率较未标化中位敉提高;运用标化中位数对DS、ES、NTD的总体检出率为10/12,高于未标化中位数的8/12。与未标化血清学指标中位数倍数值的中位数(mMoM)相比,标化血清AFP的mMoM升高,freeβ-HCG、uE_3的mMoM降低(P均<0.01)。结论经过孕周、体质量标化调整后,建立了无锡地区孕妇血清AFP、freeβ-HCG、uE_3水平中位数,与Life Cycle4.0软件内置中位数存在差异。参考标化后的AFP、freeβ-HCG、uE_3水平中位数判定筛查结果,有助于提高筛查效率。
Objective To detect the median equation of maternal serum markers including free β-human chorionic gonadotrophin(free β-h CG),alpha-fetoprotein(AFP),and unconjugated estriol(u E3) in the second trimester of singlebirth pregnant women in Wuxi and to establish the regional parameters for triple screening model based on revised gestation age and weight. We also evaluated the efficacy of this method in risk assessment of trisomy 21 syndrome(DS),trisomy 18syndrome(ES) and neural tube defect(NTD). Methods The levels of AFP,free β-h CG and μE3were detected in 8 783single-birth pregnant women(15-20+ 6gestational weeks) in Wuxi. The median of serum AFP,free β-h CG and u E3 levels were analyzed by Life Cycle 4. 0 software. And then we got the new median after adjusting the standard of gestational age and body mass. ES and NTD risk assessment was performed by using the standardized median,and the application efficiency of the median of the serum indexes before and after the standardization was compared by taking the results of the amniotic fluid karyotype analysis and the postnatal outcome as the standard. Results The median of free β-h CG in the second trimester of normal pregnant women in Wuxi was significantly higher as compared with the un-standardized median from Caucasia women(all P < 0. 01). After revising gestational age and weight,the false positive rate(4. 59%) for DS in standardized median equation was higher than that in the software built-in(3. 97%). The screening efficiency for DS,ES and NTD in standardized median equation was improved as compared with that in the software built-in. Meanwhile,the total detection rate(10/12) for DS,ES and NTD in standardized median equation was higher than that in the software built-in(8/12).Compared with the values of m Mo M in serum markers of the software built-in,the values of m Mo M in the standardized ones were higher in AFP,but lower in free β-h CG and μE3(all P < 0. 01). Conclusions The median of AFP,free β-HCG and u E3 based on standardized gestation age and weight is established,which is different from the Life Cycle 4. 0 median.The standardized median equations may help to improve the screening efficiency.
Objective To detect the median equation of maternal serum markers including free β-human chorionic gonadotrophin(free β-h CG),alpha-fetoprotein(AFP),and unconjugated estriol(u E3) in the second trimester of singlebirth pregnant women in Wuxi and to establish the regional parameters for triple screening model based on revised gestation age and weight. We also evaluated the efficacy of this method in risk assessment of trisomy 21 syndrome(DS),trisomy 18syndrome(ES) and neural tube defect(NTD). Methods The levels of AFP,free β-h CG and μE3were detected in 8 783single-birth pregnant women(15-20+ 6gestational weeks) in Wuxi. The median of serum AFP,free β-h CG and u E3 levels were analyzed by Life Cycle 4. 0 software. And then we got the new median after adjusting the standard of gestational age and body mass. ES and NTD risk assessment was performed by using the standardized median,and the application efficiency of the median of the serum indexes before and after the standardization was compared by taking the results of the amniotic fluid karyotype analysis and the postnatal outcome as the standard. Results The median of free β-h CG in the second trimester of normal pregnant women in Wuxi was significantly higher as compared with the un-standardized median from Caucasia women(all P < 0. 01). After revising gestational age and weight,the false positive rate(4. 59%) for DS in standardized median equation was higher than that in the software built-in(3. 97%). The screening efficiency for DS,ES and NTD in standardized median equation was improved as compared with that in the software built-in. Meanwhile,the total detection rate(10/12) for DS,ES and NTD in standardized median equation was higher than that in the software built-in(8/12).Compared with the values of m Mo M in serum markers of the software built-in,the values of m Mo M in the standardized ones were higher in AFP,but lower in free β-h CG and μE3(all P < 0. 01). Conclusions The median of AFP,free β-HCG and u E3 based on standardized gestation age and weight is established,which is different from the Life Cycle 4. 0 median.The standardized median equations may help to improve the screening efficiency.
引文
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[11]蓝信强,王淑惠,邓玉芝,等.威海地区妊娠中期孕妇血清标志物中位数的建立[J].中华医学遗传学杂志,2012,29(6):293-296.
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[15]Zhang J,Lambert-Messerlian G,Palomaki GE,et al.Impact of smoking on maternal serum markers and prenatal screening in the first and second trimesters[J].Prenat Diagn,2011,31(6):583-588.
[16]蒋宇林,刘俊涛,刘善英,等.唐氏综合征产前筛查指标中位数倍数值中位数监测和质量评价方法的应用分析[J].实用妇产科杂志,2014,30(2):103-107.
[17]Liu HQ,Wang YH,Wang LL,et al.Predictive value of freeβ-h CG multiple of the median for women with preeclampsia[J].Gynecol Obstet Invest,2016,81(2):137-147.
[2]苏立,吴玥丽.郑州地区20784例孕妇孕中期产前筛查结果分析[J].中国优生与遗传杂志,2012,20(2):69-71.
[3]吕时铭,沈凤贤.产前筛查与诊断的质量控制与热点问题[J].中华检验医学杂志,2013,36(1):1-5.
[4]刘颖,单庆莲.长春地区孕中期产前筛查血清标志物中位数的建立及临床应用研究[J].中国妇幼保健杂志,2011,26(31):4829-4827.
[5]吴远桥,蒋群芳,金克勤,等.金华市唐氏综合征孕中期三联筛查模型的区域性参数研究[J].浙江预防医学,2015,27(3):249-253.
[6]卓仁杰,秦小岸,张檀,等.孕中期唐氏综合征筛查中血清标志物中位数倍数校正模型[J].中国医科大学学报,2011,40(1):67-69,73.
[7]王艳化,庞泓,张戬,等.沈阳地区孕中期产前筛查母血清标志物水平中位数的探讨[J].中国妇幼保健院,2008,20(9):1141-1143.
[8]许晓红,刘辉,黄大雁,等.合肥地区唐氏综合症筛查中位数方程的研究[J].安徽医科大学学报,2014,49(1):47-50.
[9]许晓红,邓松华.产前筛查中位数和体重修正结果的临床意义[J].安徽医科大学学报,2011,46(2):158-160.
[10]李华锋,张艳丽,杨海平,等.临沂地区孕中期产前筛查血清标志物中位数方程的建立及其与体重相关性的研究[J].山东医学高等专科学校学报,2014,36(6):401-408.
[11]蓝信强,王淑惠,邓玉芝,等.威海地区妊娠中期孕妇血清标志物中位数的建立[J].中华医学遗传学杂志,2012,29(6):293-296.
[12]沈凤贤,赵丽,吕时铭,等.中孕期唐氏综合征产前筛查的质量管理[J].中华检验医学杂志,2014,37(11):870-875.
[13]Huang T,Meschino WS,Okun N,et al.The impact of maternal weight discrepancies on prenatal screening results for Down syndrome[J].Prenat Diagn,2013,33(5):471-476.
[14]TachéV,Baer RJ,Currier RJ,et al.Population-based biomarker screening and the development of severe preeclampsia in California[J].Am J Obstet Gynecol,2014,211(4):377.e1-8.
[15]Zhang J,Lambert-Messerlian G,Palomaki GE,et al.Impact of smoking on maternal serum markers and prenatal screening in the first and second trimesters[J].Prenat Diagn,2011,31(6):583-588.
[16]蒋宇林,刘俊涛,刘善英,等.唐氏综合征产前筛查指标中位数倍数值中位数监测和质量评价方法的应用分析[J].实用妇产科杂志,2014,30(2):103-107.
[17]Liu HQ,Wang YH,Wang LL,et al.Predictive value of freeβ-h CG multiple of the median for women with preeclampsia[J].Gynecol Obstet Invest,2016,81(2):137-147.