AFP、β-hCG和uE3联合检测在孕中期产前出生缺陷筛查中的应用价值

目的探讨孕中期血清甲胎蛋白(AFP)、绒毛膜促性腺激素β亚单位(β-HCG)、非结合型雌三醇(uE3)联合检测在孕中期产前出生缺陷筛查中的应用价值。方法选取2015年1月—2017年4月在我院产科门诊建卡、行常规产检并分娩的妊娠妇女3617例为研究对象,以羊水细胞染色体检查、随访分娩结局作为判断出生缺陷金标准,评价血清AFP、β-HCG、uE3三联指标在产前筛查中的临床应用价值。结果血清AFP、β-HCG和uE3联合检测发现高风险孕妇138例,其中21三体综合征高风险126例(91.30%),神经管缺陷高风险12例(8.70%),无18三体综合征高风险;在138例高风险妊娠妇女中,132例孕妇愿意接受羊膜腔穿刺行羊水细胞染色体检查,发现5例出生缺陷胎儿,其中4例为21三体综合征,1例为神经管缺陷,均于28周内实施引产;6例高风险孕妇拒绝进行羊水穿刺检查,随访至分娩结束,未发现21三体综合征、18三体综合征或神经管缺陷。血清AFP、β-HCG和uE3联合检测产前筛查诊断生缺陷的灵敏度为100%,特异度为96.32%,漏诊率为0,误诊率为3.68%,阳性预测值为3.62%,阴性预测值为100%。结论血清AFP、β-HCG和uE3联合检测进行产前筛查具有无创的优势,并且具有较高的灵敏度和阴性预测能力。

Analysis of sensitivity and specificity of AFP,beta-hCG and uE3levels in prenatal birth defect screening

Objective To investigate the clinical value of combined detection of serum alpha fetoprotein(AFP),chorionic gonadotropin beta subunit(beta-HCG)and unconjugated estrogen three alcohol(uE3)in prenatal screening for prenatal birth defects in the second trimester.Methods Pregnant women were selected in our hospital obstetric outpatient Jianka,routine examination and implementation of delivery in our hospital 3617cases from January 2015to April 2017,the time to check,and amniotic fluid cells were used to judge the follow-up delivery outcome of the gold standard in birth defects,the clinical value of prenatal screening calculation of serum AFP,-HCG and uE3triple index beta.Results Serum AFP,-HCG,uE3triple beta index found in prenatal screening high risk pregnant women in 138cases,of which 21trisomy 126high risk patients(91.30%),12cases of trisomy 18syndrome high risk comprehensive neural tube defects,0cases of high risk(8.70%);in 138cases of high risk pregnant women,132pregnant women are willing to an amniocentesis for chromosome amniocyte examination found 5cases of fetal birth defects,including 4cases of trisomy 21,1cases of neural tube defects,induced abortion were implemented in 28weeks;6cases of high risk pregnant women refused amniocentesis,followed up to the end of delivery,not found in trisomy 21comprehensive syndrome,trisomy 18and neural tube defects.Serum AFP,-HCG,uE3beta triple indexes of prenatal screening and diagnosis sensitivity of birth defects was 100%,the specificity was 96.32%,the misdiagnosis rate was 0%,the misdiagnosis rate was 3.68%,the positive predictive value was 3.62%,the negative predictive value was 100%.Conclusion Prenatal screening of serum AFP,beta-HCG and uE3has the advantages of non-invasive,and has higher sensitivity and negative predictive ability.