【摘要】 目的比较母体血清妊娠相关血浆蛋白A(PAPP-A)、甲胎蛋白(AFP)、人绒毛膜促性腺激素(β-hCG)在妊娠中晚期对非整倍体胎儿的筛查价值,探讨妊娠中晚期筛查染色体病胎儿的合适方案。方法分析2807例单胎妊娠13周~36周孕妇的血清PAPP-A、AFP、β-hCG水平及其胎儿染色体核型,对三种标记物的检出率和假阳性率进行ROC分析及χ2检验。结果⑴以假阳性率5%为水准,3种标记物单项筛查、联合筛查或3种标记物联合孕妇年龄(mAGE)筛查,检出率以单项PAPP-A及PAPP-A+AFP+β-hCG最高(58.33%)、PAPP-A+AFP+β-hCG+mAGE次之(50.00%)、单项β-hCG随后(37.50%)、单项AFP最低(8.33%);⑵5种筛查方案的检出率比较提示,单项PAPP-A、PAPP-A+AFP+β-hCG、PAPP-A+AFP+β-hCG+mAGE、单项β-hCG的检出率无显著性差异(P>0.05);但均明显高于单项AFP(P<0.05)。结论PAPP-A、AFP、β-hCG在妊娠中晚期均可作为非整倍体胎儿的筛查标记物;单项PAPP-A筛查能取得与联合方案相似的筛查效果。更多还原

【Abstract】 Objective To evaluate maternal serum pregnancy associated plasma protein A(PAPP-A),alpha-fetoprotein(AFP) and beta-human chorionic gonadotrophin(β-hCG) in screening for aneuploidy pregnancies in the second and third trimester.Methods A total of 2807 singleton pregnant women between 13 and 36 weeks of gestation were offered to screen for aneuploidy with maternal serum PAPP-A,AFP and β-hCG.Detection rate and false positive rate were calculated by statistical analysis including receiver operating characteristic(ROC) curve analysis and chi-square test.Results PAPP-A alone,PAPP-A combined with AFP and β-hCG,PAPP-A combined with AFP,β-hCG and maternal age,β-hCG alone and AFP alone would detect 58.33%,58.33%,50.00%,37.50% and 8.33% of aneuploidy fetuses respectively.Chi-square test analysis showed that the detection rates of PAPP-A alone,PAPP-A combined with AFP and β-hCG,PAPP-A combined with AFP,β-hCG and maternal age and βhCG alone were not significantly different(P>0.05).But the detection rates of them were all higher than that of AFP alone(P<0.05).Conclusion Aneuploidy can be detected by maternal serum PAPP-A,AFP and β-hCG in the second and third trimester.The value of PAPP-A alone in screening for aneuploidy is similar to that of combined programs.更多还原