孕中期高溶度Free-β-hCG预测不良妊娠结局的价值

The predictive value of elevated maternal serum β-human chorionic gonadotrophin (hCG) in adverse pregnancy outcomes in the second trimester of pregnancy.

目的探讨孕中期母血清Free-β-hCG升高与不良妊娠结局的相关性。方法采用时间分辨免疫荧光分析法对孕中期7121例孕妇进行唐氏筛查,427例孕妇血清Free-β-hCG MoM≥2.5(其中MoM≥3.5,184例;MoM≥5.0,58例)。收集妊娠结局资料进行分析,Free-β-hCG MoM在中位数周围的孕妇为对照组。结果Free-β-hCG MoM≥5.0,≥3.5,≥2.5三组中,胎膜早破均高于对照组(P<0.05);出生后需进入新生儿监护中心(NICU)特别护理的婴儿均高于对照组(P<0.05),具有统计学意义。MoM≥5.0组中,出生婴儿出生体重低于对照组(P=0.046),具有统计学意义。结论Free-β-hCG升高的孕妇处于不良妊娠结局的高风险中,对孕中期Free-β-hCG MoM≥2.5孕妇增加监护的有必要的。

Objective： To investigate the association between highly elevated maternal serum free- β -hCG in the second trimester of pregnancy and adverse outcome of pregnancy. Methods ： In a case - controlled study of 7121 women who opted for second - trimester serum screening for Down＇s syndrome , 427 were found to have a serum free - β - hCG of greater than 2. 5 multiples of the median （ MoM）, 184 of whom had a serum β - hCG of greater than 3.5 MoM and 58 of whom had a serum β - hCG of greater than 5. 0 MoM . For a large number of outcome of pregnancy , these women were compared with a control group of women with serum β - hCG MoM of around the median. Results： There was a significant effect of raised β - hCG （ ≥5, ≥3.5 and ≥2. 5 MoM） on the occurfence of PROM when compared to the control group （ P =0. 017 , 0. 039 and 0. 013 respectively ）. In the elevated β-hCG group （ ≥5, ≥3. 5 and ≥2. 5 MoM） , statistically significantly more babies were required admission to neonatal intensive care unit （ P = 0. 016 , 0. 022 and 0. 010 respectively）. The mean birth weight was also significantly lower in the group with elevated β - hCG （ ≥5 MoM） （ P = 0. 046） . Conclusion ： Women with the elevations of free - β - hCG are at increased risk for various adverse pregnancy outcomes. Increased surveillance is necessary in pregnancies where the maternal serum β - hCG in the second trimester is elevated to 2. 5 MoM.