【摘要】 目的探讨实时三维超声联合母体血清甲胎蛋白(AFP)、游离β-hCG(Freeβ-hCG)、游离雌三醇(uE3)对胎儿神经管畸形的早期诊断效果。方法选取2 862例孕妇作为研究对象,均接受实时三维超声检查,并采集母体外周血检测血清AFP、Freeβ-hCG、uE3水平。分析实时三维超声、血清生化标记物单用与联用对胎儿神经管畸形的诊断效能。结果胎儿神经管畸形20例(0.70%)。实时三维超声阳性21例(0.73%),母体血清三项检测阳性36例(1.36%)。实时三维超声联合母体血清三项检出胎儿神经管畸形21例(0.73%),19例与病理结果相符,漏诊1例,误诊1例。实时三维超声、血清三项单用对胎儿神经管畸形的诊断灵敏度、特异度、阴性预测值接近(P>0.05);与实时三维超声、血清三项单用相比,超声+AFP对胎儿神经管畸形的诊断灵敏度、阳性预测值明显更高(P<0.05)。结论在胎儿神经管畸形的早期筛查中,联合应用实时三维超声和母体血清AFP、Freeβ-hCG、uE3检测可有效提高诊断的灵敏度,降低漏误诊风险。更多还原

【Abstract】 Objective To investigate the effect of real time 3 D ultrasound combined with serum alpha-fetoprotein(AFP), Free β-hCG, Free estriol(uE3) in the early diagnosis of fetal neural tube malformation. Methods 2 862 pregnant women were examined by dimensional ultrasound, and the maternal peripheral blood was collected to detect the level of Serum AFP, Free β-hCG and uE3. The diagnostic efficacy of real time 3 D ultrasound and serum biochemical markers in fetal neural tube malformation were analyzed. Results 20 cases(0.70%) had neural tube malformation. 21 cases(0.73%) were positive in real time 3 D ultrasound and 36 cases(1.36%) in maternal serum. 21 cases(0.73%) of fetal neural tube malformation were detected by real time 3 D ultrasound combined with maternal serum three items, 19 cases were consistent with pathological results, 1 case was missed and 1 case was misdiagnosed. The diagnostic sensitivity, specificity and negative predictive value of fetal neural tube malformation were close to those of real time 3 D ultrasound and serum alone(P>0.05); compared with real time 3 D ultrasound and serum alone, the diagnostic sensitivity and positive predictive value of real time 3 D ultrasound +AFP for fetal neural tube malformation were significantly higher(P<0.05). Conclusions In the early screening of fetal neural tube malformation, the combination of real time 3 D ultrasound and maternal serum AFP, Free β-hCG and uE3 can effectively improve the sensitivity of diagnosis and reduce the risk of misdiagnosis.更多还原