孕早期血清学联合超声检测NT厚度筛查唐氏综合征高风险与妊娠不良结局的相关性研究

Correlation between high risk of Down's syndrome screened by early pregnancy serological test combined with ultrasound detection of NT thickness and adverse pregnancy outcomes

目的探讨孕早期血清学联合超声检测NT厚度筛查唐氏综合征高风险与妊娠不良结局的相关性。方法选取赣州市人民医院2017年9月~2019年4月行孕早期血清学及超声NT联合DS筛查的11~13+6孕周的孕妇300例,均接受血清学检测,包括妊娠相关血浆蛋白-A(PAPP-A)与游离绒毛膜促性腺激素(Freeβ-hCG)的检测,根据DS风险值分为高风险组100例,低风险组200例,高风险组(包括NT≥3.0 mm)及年龄≥35岁高龄孕妇建议其行介入产前诊断。所有孕妇在孕18~24周对胎儿做系统的超声检查。建议超声结果异常的孕妇行产前介入性的诊断。对研究对象进行是否进行产前诊断、有无妊娠并发症、Apgar评分、有无畸形情况的病案随访和电话随访。结果高风险组中产前诊断患者的比例为35.00%,明显高于低风险组产前诊断患者的比例10.00%,差异有统计学意义(P<0.05)。高风险组的PAPP-A水平明显低于低风险组,Freeβ-hCG水平明显高于低风险组,差异均有统计学意义(P<0.05)。高风险组的NT厚度明显厚于低风险组,差异有统计学意义(P<0.05)。高风险组的畸形发生率为49.00%,明显高于对照组的7.00%,差异有统计学的意义(P<0.05)。高风险组的Apgar评分明显高于低风险组,差异有统计学意义(P<0.05)。高风险组与低风险组的妊娠并发症发生率分别为27.00%与24.50%,差异无统计学意义(P>0.05)。结论孕早期血清学联合超声检测NT厚度筛查唐氏综合征高风险者发生妊娠不良结局的比例较高,具有重要的临床意义。

Objective To explore the association between high risk of Down's syndrome screened by early pregnancy serological test combined with ultrasound detection of NT thickness.Methods 300 pregnant women from 11-13+6 gestational weeks who were screened for DS by early pregnancy serology and ultrasound NT in Ganzhou People's Hospital from September 2017 to April 2019 were selected.All received serological tests,including the detection of pregnancy-related plasma protein-A(PAPP-A)and free chorionic gonadotropin(Freeβ-hCG).The patients were divided into high-risk group(100 cases)and low-risk group(200 cases)according to DS risk value.The high-risk group(including NT≥3.0 mm)and pregnant women aged≥35 years were recommended to undergo prenatal diagnosis.All pregnant women underwent a systematic ultrasound examination of the fetus from 18 to 24 weeks of gestation.Prenatal interventional diagnosis was recommended for pregnant women with abnormal ultrasound results.Participants were followed up for prenatal diagnosis,pregnancy complications,Apgar scores,and malformations.Results The proportion of prenatally diagnosed patients in the high-risk group was 35.00%,which was significantly higher than the proportion of prenatally diagnosed patients in the low-risk group 10.00%.And the difference was statistically significant(P<0.05).The level of PAPP-A in the high-risk group was significantly lower than that in the low-risk group,and the level of Freeβ-hCG was significantly higher than that in the low-risk group.The differences were statistically significant(P<0.05).The thickness of NT in the high-risk group was significantly thicker than that in the low-risk group,and the difference was statistically significant(P<0.05).The incidence of deformities in the high-risk group was 49.00%,which was significantly higher than the 7.00%in the control group,and the difference was statistically significant(P<0.05).Apgar scores in the high-risk group were significantly higher than those in the low-risk group,and the difference was statistically significant(P<0.05).The incidence of pregnancy complications in the high-risk group and the low-risk group was 27.00%and 24.50%,respectively,and the difference was not statistically significant(P>0.05).Conclusion High-risk patients with Down syndrome screened by early pregnancy serological test combined with ultrasound detection of NT thickness have a higher proportion of adverse pregnancy outcomes,which has important clinical significance.