9033例孕中期血清学筛查唐氏综合征模拟调整结果分析

发布时间：2018-06-24 09:47

本文选题：产前筛查 + 唐氏综合征　；参考：《解放军医学杂志》2017年04期

【摘要】：目的探讨降低唐氏综合征产前血清学筛查的筛查阳性率(SPR),提高血清学筛查临床效能的方法。方法回顾性分析2013年4月-2014年4月9033例孕中期唐氏综合征血清学筛查的结果、各基础数据和方程曲线的变化情况,以本实验室数据为基准数据,对于重要调节参数进行模拟调整,结合产后随访结果评估孕中期血清学筛查唐氏综合征的准确性。结果 9033例孕妇孕中期血清学筛查的筛查阳性率为6.69%(604/9033),检出率(DR)为75%(3/4),假阳性率(FPR)为6.65%(601/9033)。甲胎蛋白(AFP)的中位数倍数(MOM)值中位数偏低,SPR偏高;人绒毛膜促性腺激素游离β亚基(free hCGβ)MOM值中位数偏高,SPR偏高;游离雌三醇(uE3)MOM值中位数略微偏低,SPR略微偏高。综合三种因素,认为筛查阳性率处于偏高的状态。模拟调整AFP和free hCGβ的MOM值方程及体重校正方程,重新评估样本的风险值,高风险孕妇比率降为4.11%(371/9033),FPR降为4.07%(368/9033),并且按调整方程后的筛查结果经随访与原方程一致。结论根据本实验室人群的数据进行本地化设置,定期对孕妇的AFP、free hCGβ、uE3的MOM值分布及体重进行校正,对降低唐氏综合征产前血清学筛查FPR具有重要意义。
[Abstract]:Objective to study the method of reducing the screening positive rate (SPR) and improving the clinical efficacy of Down's syndrome prenatal serological screening. Methods the results of serological screening of 9033 cases of Down's syndrome from April 2013 to April 2014 were retrospectively analyzed, and the changes of basic data and equation curves were analyzed. The important adjustment parameters were simulated and the accuracy of screening for Down's syndrome was evaluated by postpartum follow-up. Results the positive rate, Dr and false positive rate of 9033 pregnant women were 6.69% (604 / 9033), 75% (3 / 4) and 6.65% (601 / 9033) respectively. The median of free hCG 尾 subunit (mom) of human chorionic gonadotropin (hCG 尾) was higher than that of AFP, and the median of free estrin (UE3) mom was slightly lower than that of human chorionic gonadotropin (free hCG 尾). Combined with three factors, the positive rate of screening was considered to be on the high side. The mom value equation and weight correction equation of free hCG 尾 were adjusted to re-evaluate the risk value of the sample. The ratio of high-risk pregnant women was reduced to 4.11% (371 / 9033) and 4.07% (368 / 9033). The results of screening according to the adjusted equation were in accordance with the original equation. Conclusion according to the data of our laboratory, localizing the distribution of mom and weight of AFPfree hCG 尾 -UE3 in pregnant women is of great significance in reducing the FPR of Down's syndrome prenatal serological screening.
【作者单位】：解放军总医院妇产科;
【分类号】：R714.53

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