福州地区早产儿先天性肾上腺皮质增生症筛查实验切值讨论

Screening experimental cut-off values of congenital adrenal cortical hyperplasia among premature infants in Fuzhou area

目的确立合理的福州市早产儿先天性肾上腺皮质增生症(CAH)筛查指标的切值。方法对2013年11月-2014年11月在福建省妇幼保健院出生的2 013例非CAH活产早产儿(胎龄<37周)进行回顾性分析,新生儿出生满72 h并充分哺乳后,采集足跟血滴于筛查专用滤纸片上,自然晾干后,采用时间分辨荧光免疫分析法(TRFIA)检测17α-羟孕酮(17α-OHP)的血浓度,采用百分位数法来确定切值。结果 2 013例早产儿中正常体重(≥2 500 g)654例,95%、99%分位数值分别24.7 nmol/L和38.5 nmol/L;低体重早产儿(<2 500 g)1 359例,95%、99%分位数值分别36.5 nmol/L和54.3 nmol/L。正常体重早产儿17α-OHP浓度切值为30.0 nmol/L,低体重早产儿17α-OHP浓度切值为40.0 nmol/L,两组比较差异有统计学意义(P<0.05)。结论早产儿17α-OHP切值的确立对福州地区CAH筛查具有重要临床意义。

Objective To establish rational cut-off values of screening index of congenital adrenal cortical hyperplasia （CAH） a- mong premature infants in Fuzhou area. Methods A total of 2 013 alive premature infants （less than 37 gestational week） without CAH born in the hospital from November 2013 to November 2014 were analyzed retrospectively, after 72 hours of birth, the neonates were fed fully, heel blood samples were obtained to prepare blood spot specimens, after drying in the air, time-resolved fluorescence immunoassay （TRFIA） was used to detect the concentrations of blood 17α-hydroxyprogesterone （17α-OHP）, percentile method was used to calculate cut-off values. Results Among 2 013 premature infants, birth weight of 654 infants was normal （ ≥2 500 g）, 95% and 99% percentages were 24. 7 nmol/L and 38. 5 nmol/L, respectively; birth weight of 1 359 infants was low （〈2 500 g）, 95% and 99% percentages were 36. 5 nmol/L and 54. 3 nmol/L, respectively; the cut-off values of 17α-OHP concentrations among normal weight premature infants and low birth weight premature infants were 30. 0 nmol/L and 40. 0 nmol/L, respectively, there was statistically significant difference （P〈0. 05 ） . Conclusion The establishment of cut-off values of neonatal screening for CAH among premature infants has important clinical significance.