【摘要】 目的通过Meta分析的方法对中国人群孕中期AFP联合β-HCG进行唐氏综合征产前筛查的价值进行系统性评价。方法通过计算机及手工检索ISI Web of knowledge、PubMed、High-wire、中国期刊全文数据库、万方数据库(1990~2010年)中关于中国人群孕中期唐氏综合征筛查的文献,按照纳入和排除标准筛查所获得的文献,提取文献特征及四格表信息。利用Meta disc1.4软件分析所提取的数据信息,进行异质性检验,根据检验结果选择相应的效应模型,利用所选择的效应模型进行分析,最终获得汇总灵敏度、特异度、阳性似然比、阴性似然比、比值比,并绘制受试者工作特征(SROC)曲线,对孕中期AFP联合β-HCG二联生化指标筛查唐氏综合征的价值作出综合评价。结果共纳入9篇文献,其中中文8篇,英文1篇,共筛查孕妇102107例,经过异质性检验,无阈值效应,亦不存在非阈值效应,遂采用固定效应模型进行Meta分析,结果显示:汇总灵敏度、特异度、阳性似然比、阴性似然比、OR值及SROC曲线下面积分别为0.89(95%CI0.83~0.93)、0.92(95%CI0.93~0.92)、11.59(95%CI10.95~12.27)、0.13(95%CI0.08~0.20)、109.27(95%CI65.23~183.05)、0.9705。结论中国人群孕中期AFP联合β-HCG二联生化指标筛查唐氏综合征的灵敏度及特异度均较高,是很好的唐氏综合征的产前筛查方法 ,适于在中国人群中大规模开展。更多还原

【Abstract】 Objective To systematically evaluate the value of AFP andβ-HCG in the second trimester for the prenatal screening of Down’s syndrome in Chinese people by Meta-analysis.Methods An electronic search and manual tracking in ISI Web of knowledge,PubMed,Highwire,China National Knowledge Infrastructure(CNKI)and Wanfang Chinese Periodical Database were performed to retrieve relevant studies on prenatal screening for Down’s syndrome in the second trimester in Chinese people from 1990 to 2010.All literatures were screened by the standards of internalizing and depleting.Characteristics fourfold table information were extracted.The data extracted from the literatures was analyzed using Meta disc 1.4 software,meanwhile,heterogeneity of the included articles was tested.According to the results,proper effect model was selected.Pooled weighted sensitivity,specificity and likelihood ratio were calculated eventually.Also,summary receiver operating characteristic(SROC)curve was drawn.At last,synthetic evaluation for the value of AFP and β-HCG in the second trimester for the prenatal screening of Down’s syndrome was acquired.Results Nine articles were included,with a total of 102 107 pregnant women.Heterogeneity wasn’t found either for threshold effect or non-threshold effect,so Meta-analysis was performed using the fixed effect model.The results were here:The pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,odds ratio and the area under SROC curve was 0.89(95% CI 0.83-0.93),0.92(95% CI 0.93-0.92),11.59(95% CI 10.95-12.27),0.13(95% CI 0.08-0.20),109.27(95% CI 65.23-183.05),0.9705.Conclusions The pooled sensitivity and specificity were both high of AFP and β-HCG in the second trimester for the prenatal screening of Down’s syndrome which was a good method for screening Down’s syndrome before delivery.更多还原