实时三维超声联合母体血清三联生化标记物在胎儿神经管畸形早期筛查中的应用

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。

Application of Real Time 3D Ultrasound Combined With Maternal Serum Triple Biochemical Markers in Early Screening of Fetal Neural Tube Defects

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.