胎儿超声NT联合血清PIGF、ADAM12、uE3检测在唐氏综合征的早期预测中的价值分析

Value of fetal ultrasound NT combined with serum PIGF,ADAM12 and uE3 in early prediction of Down's syndrome

目的探讨胎儿超声颈项透明层厚度(NT)联合血清胎盘生长因子(PIGF)、解整合素-金属蛋白酶12(ADAM12)、游离雌三醇(uE3)检测对唐氏综合征(DS)的早期预测价值。方法回顾性分析2017年2月至2018年2月间于空军军医大学第一附属医院行产检的500例孕妇资料,使用超声检测胎儿NT,并检测孕妇血清中PIGF、ADAM12、uE3水平,以羊膜穿刺检测胎儿染色体情况为金标准,分析超声检测胎儿NT联合血清PIGF、ADAM12、uE3预测DS的价值。观察不同风险程度孕妇的异常妊娠结局率。结果单纯超声检测确诊11例DS胎儿,阳性率为2.20%(11/500),单纯血清检测确诊12例DS胎儿,阳性率为2.40%(12/500),联合检测确诊13例DS胎儿,阳性率为2.60%(13/500);单纯超声检测诊断DS的灵敏度、特异度分别为67.67%、94.77%,单纯血清检测诊断DS的灵敏度、特异度分别为73.31%、95.38%,联合检测诊断DS的灵敏度、特异度分别为92.86%、96.79%;受试者工作特征(ROC)曲线结果显示,单纯超声、血清检测的曲线下面积分别为0.630、0.660,对DS的预测价值不高;联合检测的曲线下面积为0.720,对DS具有一定的预测价值。联合筛查出的结果中,高风险孕妇的异常妊娠结局率(15.38%)明显高于低风险孕妇(1.44%),差异有统计学意义(P<0.05)。结论胎儿超声NT联合血清PIGF、ADAM12、uE3检测的DS早期预测价值高于单项筛查,值得临床推广。

Objective To explore the early predictive value of fetal ultrasound neck thickness(NT)combined with serum placental growth factor(PIGF),disintegrin-metalloproteinase 12(ADAM12),and free estriol(uE3)for Down's syndrome(DS).Methods Retrospective analysis of data of 500 pregnant women who underwent maternity check-ups at First Affiliated Hospital of the Air Force Military Medical University from February 2017 to February 2018.Ultrasound was used to detect fetal NT,and the levels of PIGF,ADAM12,and uE3 in the serum of pregnant women were detected.Amniocentesis was used as the gold standard to detect fetal chromosomes.The value of ultrasound detection of fetal NT combined with serum PIGF,ADAM12,uE3 in predicting DS was analyzed.The abnormal pregnancy outcome rate of pregnant women with different risk levels was observed.Results Eleven cases of DS fetuses were diagnosed by ultrasound alone,the positive rate was 2.20%(11/500),12 cases of DS fetuses were diagnosed by pure serum test,the positive rate was 2.40%(12/500),and 13 cases of DS fetuses were diagnosed by combined detection,the positive rate was 2.60%(13/500);the sensitivity and specificity of the diagnosis of DS by ultrasound alone were 67.67%and 94.77%,respectively,the sensitivity and specificity of the diagnosis of DS by serum detection were 73.31%,95.38%,the sensitivity and specificity of combined detection in the diagnosis of DS were 92.86%and 96.79%,respectively;the receiver operating characteristic curve(ROC curve)results showed that the area under the curve for pure ultrasound and serum detection was 0.630 and 0.660,respectively,which was low predictive value for DS;combined detection The area under the curve was 0.720,which had certain predictive value for DS.In the combined screening results,the abnormal pregnancy outcome rate of high-risk pregnant women(15.38%)was significantly higher than that of low-risk pregnant women(1.44%),and the difference was statistically significant(P<0.05).Conclusion The early predictive value of fetal ultrasound combined with serum PIGF,ADAM12,and uE3 is higher than single screening,which is worthy of clinical promotion.