孕早期B超测NT联合母体血清指标筛查唐氏综合征的Meta分析

Fetal nuchal translucency detection during early pregnancy by ultrasound combined with maternal serum indexes detection in screening of Down syndrome:a meta analysis

目的探讨B超检测NT联合母体血清F-β-HCG、PAPP-A筛查孕早期胎儿唐氏综合征的诊断价值。方法计算机检索维普中文科技期刊数据库、中国期刊全文数据库、万方数据库、中国生物医学文献数据库、Pubmed,Embase and Cochrane Library Databases等（时间截止到2012年9月）,获得B超测NT联合母体血清F-β-HCG、PAPP-A筛查孕早期胎儿唐氏综合征的文献。采用QUADAS工具对收纳文献进行质量评价。采用Metadisc1.4软件,计算灵敏性、特异性及95%CI,并描绘受试者工作特性曲线（SROC）,计算曲线下面积（AUC）,并进行敏感性分析。采用Stata/SE12.0绘制Deeks漏斗图计算发表性偏倚。结果符合纳入标准文献23篇进入Meta分析,汇总灵敏度和特异度分别为0.89（95%CI：0.88%～0.90）及0.96（95%CI：0.96%～0.96）。经异质性检验发现存在非阈值效应引起的异质性,故行亚组分析。当危险界值〉1∶300时,灵敏度可达91%（95CI：88%～93%）,特异度可达95%（95%CI：95%～95%）;当危险界值〉1∶270时,灵敏度为88%（95%CI：82%～93%）,特异度为95%（95%CI：94%～95%）;当危险界值〉1∶250时,灵敏度可达81%（95%CI：77%～84%）,特异度可达95%（95%CI：96%～96%）;当危险界值〉1∶200时,灵敏度可达89%（95%CI：86%～92%）,特异度可达95%（95%CI：95%～95%）;当危险界值〉1：100时,汇总灵敏度和特异性分别为灵敏度可达92%（95%CI：90%～93%）,特异度可达97%（95%CI：97%～97%）。合并以上分组的汇总SROC AUC为0.981,Q指数为0.940。结论 B超测NT联合母体血清F-β-HCG、PAPP-A能显著提高筛查胎儿唐氏综合征准确性,有助于孕早期诊断胎儿唐氏综合征。

Objective To explore the value of fetal nuchal translucency detection during early pregnancy by ultrasound combined with maternal serum free β- human chorionic gonadotropin（ F-β-hCG）,pregnancy- associated plasma protein A（ PAPP-A） detection in screening of Down syndrome. Methods Literature search was performed among VIP,CNKI,Wanfang,CBMdisc,Pubmed,Embase,and Cochrane Library Databases,the dealine was September 2012,the literatures about fetal nuchal translucency detection during early pregnancy by ultrasound combined with maternal serum F-β-hCG,PAPP-A detection in screening of Down syndrome were obtained. Quality evaluation of the inclusion literatures was conducted based on QUADAS. Metadisc 1. 4 software was used to calculate sensitivity,specificity,and 95% CI,summary receiver operating characteristic（ SROC） curve was performed,the area under the curve（ AUC） was calculated. Sensitivity analysis was conducted,Stata / SE12. 0 software was used to draw Deeks funnel chart,publication bias was calculated. Results A total of 23 literatures were included into mata analysis,the summary sensitivity and specificity were 0. 89（ 95% CI： 0. 88%- 0. 90） and 0. 96（ 95% CI： 0. 96%-0. 96）,respectively. Heterogeneity test found heterogeneity induced by non-threshold effect,so subgroup analysis was performed. When the risk cut-off value was more than 1 ∶ 300,the sensitivity and specificity were 91%（ 95CI： 88%-93%） and 95%（ 95% CI： 95%-95%）,respectively. When the risk cut-off value was more than 1 ∶ 270,the sensitivity and specificity were 88%（ 95%CI： 82%-93%） and 95%（ 95% CI： 94%-95%）,respectively. When the risk cut-off value was more than 1 ∶ 250,the sensitivity and specificity were 81%（ 95% CI： 77%-84%） and 95%（ 95% CI： 96%-96%）,respectively. When the risk cut-off value was more than1 ∶ 200,the sensitivity and specificity were 89%（ 95% CI： 86%-92%） and 95%（ 95% CI： 95%-95%）,respectively. When the risk cut-off value was more than 1 ∶ 100,the sensitivity and specificity were 92%（ 95% CI： 90%-93%） and 97%（ 95% CI： 97%-97%）,respectively. The summary SROC AUC and Q index were 0. 981 and 0. 940,respectively. Conclusion Fetal nuchal translucency detection during early pregnancy by ultrasound combined with maternal serum F-β-hCG,PAPP-A detection can significantly improve the accuracy of Down syndrome screening,which is helpful to diagnose fetal Down syndrome during early pregnancy.