产前筛查中孕中期孕妇uE_3、AFP和Freeβ-HCG检测及超声的应用价值

Application value of uE_3,AFP and Freeβ-HCG detection and ultrasound for pregnant metaphase women in prenatal screening

目的着重于探讨甲胎蛋白(AFP)、游离雌三醇(uE_3)和游离人绒毛促性腺激素β亚单位(Freeβ-HCG)检测及超声在孕中期孕妇产前筛查中的应用价值。方法对3500例产检孕中期的孕妇进行研究,给予产前AFP、uE_3与Freeβ-HCG检测联合超声诊断,分析诊断效果与价值。结果 3500例孕中期孕妇查出高风险孕妇152例,约占4.34%(152/3500),高风险孕妇包括24例(15.79%)18三体高风险,114例(75.00%)唐氏综合征高风险,14例(9.21%)神经管缺陷高风险;查出低风险孕妇3348例,约占96.66%。经产前诊断发现2例(0.06%)神经管缺陷,3例(0.09%)唐氏综合征,1例(0.03%)18三体;对不符合分娩要求者终止妊娠。在超声胎盘异常诊断中,高风险孕妇胎盘异常率21.05%(32/152),低风险孕妇的胎盘异常率为3.17%(106/3348),两者胎盘异常率比较差异具有统计学意义(P<0.05)。高风险孕妇与低风险孕妇静脉导管血流异常率分别为4.61%(7/152)、0.51%(17/3348),比较差异具有统计学意义(P<0.05)。在不良妊娠结局诊断中,产前AFP、uE_3与Freeβ-HCG检测联合超声诊断的单项异常阳性预测值为25.62%,同时异常阳性预测值为79.63%,单项异常与同时异常的阳性预测值比较差异具有统计学意义(P<0.05)。结论产前AFP、uE_3与Freeβ-HCG检测联合超声诊断能够有效检出高风险孕妇,及时采取终止妊娠措施避免对孕妇的生命与健康造成危害,临床应用价值极高。

Objective To mainly investigate application value of alpha fetoprotein（AFP）, uncojugated estriol（uE3） and free human chorionic gonadotropin β sigmasubunit（Freeβ-HCG） detection and ultrasound for pregnant metaphase women in prenatal screening. Methods A total of 3500 pregnant metaphase women in prenatal examination were taken into research, and they received prenatal AFP, uE3 and Freeβ-HCG detection combined with ultrasound for diagnosis. Analysis was made on diagnostic effect and value. Results Among the 3500 pregnant metaphase women, there were 152 high risk cases, accounting for 4.34%（152/3200）, including 24 cases（15.79%） with high risk of trisomy 18 syndrome, 114 cases（75.00%） with high risk of Down’s syndrome, and 14 cases（9.21%） with high risk of neural tube defects, and there were 3348 low risk cases, accounting for 96.66%. Prenatal diagnosis sowed 2 cases（0.06%） with neural tube defects, 3 cases（0.09%） with Down’s syndrome and 1 case（0.03%） with trisomy 18 syndrome. Termination of pregnancy was applied in unqualified patients. Diagnosis of placental abnormality by ultrasound showed placental abnormality rate in high risk pregnant women as 21.05%（32/152） and 3.17%（106/3348） in low risk pregnant women, and their difference of placental abnormality rate had statistical significance（P〈0.05）. High risk pregnant women and low risk pregnant women had venous conduit blood flow abnormality rate respectively 4.61%（7/152） and 0.51%（17/3348）, and their difference had statistical significance（P〈0.05）. In diagnosis of adverse pregnancy outcomes, prenatal AFP, uE3 and Freeβ-HCG detection combined with ultrasound had single abnormal positive predictive value as 25.62% and simultaneous abnormal positive predictive value as 79.63%. The difference of single abnormal positive predictive value and simultaneous abnormal positive predictive value had statistical significance（P〈0.05）. Conclusion Diagnosis by prenatal AFP, uE3 and Freeβ-HCG detection combined with ultrasound can effectively detect high risk pregnant women, and timely implement of pregnancy termination measures can prevent harm to safety and health of pregnant women. This method contains remarkably high value for clinical application.