孕龄、年龄、体重对产前筛查影响的研究
发布时间：2019-05-03 18:59
【摘要】：目的 研究早孕期和中孕期产前筛查唐氏综合征、爱德华综合征和开放性神经管缺陷风险值与孕妇年龄、体重、孕龄的关系,探讨影响产前筛查的因素,从而避免相关因素的影响,降低产前筛查的假阴性和假阳性,提高产前筛查的准确率。 研究对象和方法 回顾性分析在2011年1月至2012年12月进行早中孕期产前筛查的健康单胎妊娠孕妇共73789例。用全自动时间分辨荧光免疫分析仪检测孕妇血清中妊娠相关血浆蛋白A(PAPP-A)、甲胎蛋白(AFP)、游离人绒毛膜促性腺激素β-亚单位(Free-βhCG)、游离雌三醇(uE3)水平,应用风险评估软件系统,结合孕妇年龄、体重、孕周等因素校正后分别得出3种先天缺陷的风险值,采用x2检验和相关性分析进行数据的统计分析。 结果 1.早孕期12042例孕妇共筛查出唐氏综合征阳性668例,占5.54%(668/12042)；爱德华综合征阳性80例,占0.66%(80/12042)。中孕期61747例孕妇共筛查出唐氏综合征阳性4896例,占7.92%(4896/61747)；开放性神经管缺陷高风险392例,占0.63%(392/61747)；爱德华综合征阳性385例,占0.62%(385/61747)。 2.早孕期妊娠相关蛋白A(PAPP-A)中位数浓度值随着孕龄的增加逐渐升高,早孕期和中孕期游离人绒毛膜促性腺激素β-亚单位(Free-βhCG)中位数浓度值均随着孕龄增加逐渐下降,中孕期甲胎蛋白(AFP)中位数浓度值随着孕龄的增加逐渐升高,游离雌三醇(uE3)中位数浓度值随着孕龄的增加逐渐升高；各血清学指标的中位数浓度值均随着孕妇体重的增加而逐渐下降。 3.唐氏综合征及爱德华综合征的假阳性率与年龄相关(均P0.05),均随年龄增大筛查阳性率增高,且在孕妇年龄在30岁以上的各组间筛查高风险率明显升高,而ONTD假阳性率则在各年龄组间无统计学差异(P0.05)。体重因素,三种疾病筛查风险值均与体重相关(r=0.018)。孕龄因素,ONTD的检出与孕龄相关(P0.05),唐氏综合征及爱德氏综合征的检出与孕龄无关(均P0.05)。 结论 1.唐氏综合征及爱德华综合征的筛查风险值与孕妇年龄相关,均随年龄增大筛查阳性率增高；而ONTD风险值与孕妇年龄无相关性。这三种疾病筛查风险值受到孕妇体重的影响。ONTD的检出与孕周相关,唐氏综合征及爱德氏综合征的检出与孕周不相关。 2.孕周、体重、年龄均会对唐氏综合征筛查的结果有影响,因此在临床工作中要准确掌握并填写进行产前筛查孕妇的相关信息,才能提高产前筛查的效率。
[Abstract]:Objective to study the relationship between the risk of Down's syndrome, Eduard's syndrome and open neural tube defects in early and middle trimester of pregnancy and the age, weight and gestational age of pregnant women, and to explore the factors influencing prenatal screening. So as to avoid the influence of related factors, reduce the false negative and false positive of prenatal screening, and improve the accuracy of prenatal screening. Participants and methods A retrospective analysis of 73789 healthy singleton pregnant women undergoing prenatal screening during early and middle pregnancy from January 2011 to December 2012 was conducted. Pregnancy-associated plasma protein A (PAPP-A) and alpha-fetoprotein (AFP), free human chorionic gonadotropin 尾-subunit (Free- 尾-hCG) were detected by automatic time-resolved fluorescence immunoassay. Free estriol (uE3) level, risk assessment software system, combined with pregnant women's age, body weight, gestational weeks and other factors were adjusted to obtain the risk values of three kinds of congenital defects, using x2 test and correlation analysis for statistical analysis of the data. Outcome 1. A total of 668 cases (5.54%) were positive for Down's syndrome and 80 cases (0.66%) were positive for Edward's syndrome during the first trimester of pregnancy. 4896 cases (7.92%) were positive for Down's syndrome, and 392 cases (0.63%) were at high risk of open neural tube defects (392%, 392%), and 392 cases (0.63%) were found to be positive for Down's syndrome in 61747 pregnant women during the second trimester of pregnancy. The positive rate of Eduard's syndrome was 0.62% (385 / 61747). 2. The median concentration of pregnancy-associated protein A (PAPP-A) in the first trimester increased with the increase of gestational age. The median concentration of free human chorionic gonadotropin 尾-subunit (Free- 尾-hCG) decreased gradually with the increase of gestational age, and the median concentration of alpha-fetoprotein (AFP) increased with the increase of gestational age. The median concentration of free estriol (uE3) increased with the increase of gestational age. The median concentration of each serological index decreased with the increase of pregnant women's weight. 3. The false positive rates of Down's syndrome and Edward's syndrome were correlated with age (P0.05), and the positive rate of screening increased with age, and the high risk rate of screening among pregnant women over 30 years old was significantly higher than that of normal women (P < 0.05). There was no significant difference in the false positive rate of ONTD among different age groups (P0.05). Weight factors, screening risk values for all three diseases were associated with weight (r = 0.018). Gestational age factors, the detection of ONTD was correlated with gestational age (P0.05), Down's syndrome and Edwards syndrome were not associated with gestational age (all P0.05). Conclusion 1. The screening risk of Down's syndrome and Edward's syndrome was correlated with the age of pregnant women, and the positive rate of screening increased with age, but the risk of ONTD was not correlated with the age of pregnant women. The detection of ONTD was correlated with gestational weeks, while Down's syndrome and Edwards' syndrome were not associated with gestational weeks. 2. Gestational weeks, weight and age all affect the results of Down's syndrome screening. Therefore, it is necessary to accurately grasp and fill in the relevant information of prenatal screening for pregnant women in clinical work, in order to improve the efficiency of prenatal screening.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.5
本文编号：2469187
[Abstract]:Objective to study the relationship between the risk of Down's syndrome, Eduard's syndrome and open neural tube defects in early and middle trimester of pregnancy and the age, weight and gestational age of pregnant women, and to explore the factors influencing prenatal screening. So as to avoid the influence of related factors, reduce the false negative and false positive of prenatal screening, and improve the accuracy of prenatal screening. Participants and methods A retrospective analysis of 73789 healthy singleton pregnant women undergoing prenatal screening during early and middle pregnancy from January 2011 to December 2012 was conducted. Pregnancy-associated plasma protein A (PAPP-A) and alpha-fetoprotein (AFP), free human chorionic gonadotropin 尾-subunit (Free- 尾-hCG) were detected by automatic time-resolved fluorescence immunoassay. Free estriol (uE3) level, risk assessment software system, combined with pregnant women's age, body weight, gestational weeks and other factors were adjusted to obtain the risk values of three kinds of congenital defects, using x2 test and correlation analysis for statistical analysis of the data. Outcome 1. A total of 668 cases (5.54%) were positive for Down's syndrome and 80 cases (0.66%) were positive for Edward's syndrome during the first trimester of pregnancy. 4896 cases (7.92%) were positive for Down's syndrome, and 392 cases (0.63%) were at high risk of open neural tube defects (392%, 392%), and 392 cases (0.63%) were found to be positive for Down's syndrome in 61747 pregnant women during the second trimester of pregnancy. The positive rate of Eduard's syndrome was 0.62% (385 / 61747). 2. The median concentration of pregnancy-associated protein A (PAPP-A) in the first trimester increased with the increase of gestational age. The median concentration of free human chorionic gonadotropin 尾-subunit (Free- 尾-hCG) decreased gradually with the increase of gestational age, and the median concentration of alpha-fetoprotein (AFP) increased with the increase of gestational age. The median concentration of free estriol (uE3) increased with the increase of gestational age. The median concentration of each serological index decreased with the increase of pregnant women's weight. 3. The false positive rates of Down's syndrome and Edward's syndrome were correlated with age (P0.05), and the positive rate of screening increased with age, and the high risk rate of screening among pregnant women over 30 years old was significantly higher than that of normal women (P < 0.05). There was no significant difference in the false positive rate of ONTD among different age groups (P0.05). Weight factors, screening risk values for all three diseases were associated with weight (r = 0.018). Gestational age factors, the detection of ONTD was correlated with gestational age (P0.05), Down's syndrome and Edwards syndrome were not associated with gestational age (all P0.05). Conclusion 1. The screening risk of Down's syndrome and Edward's syndrome was correlated with the age of pregnant women, and the positive rate of screening increased with age, but the risk of ONTD was not correlated with the age of pregnant women. The detection of ONTD was correlated with gestational weeks, while Down's syndrome and Edwards' syndrome were not associated with gestational weeks. 2. Gestational weeks, weight and age all affect the results of Down's syndrome screening. Therefore, it is necessary to accurately grasp and fill in the relevant information of prenatal screening for pregnant women in clinical work, in order to improve the efficiency of prenatal screening.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.5
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