辅助生殖单胎妊娠的唐氏筛查血清标记物水平分析

Analysis of serum marker levels of Down's screening in assisted reproduction single pregnancy

目的探讨新鲜周期胚胎移植妊娠、冷冻周期胚胎移植妊娠与自然妊娠早中孕期唐氏筛查血清标记物水平及检出率差异。方法经辅助生殖技术受孕单胎妊娠孕妇3550例,其中唐氏筛查早孕1231例,新鲜周期胚胎移植338例(早孕鲜胚组),冷冻周期胚胎移植893例(早孕冻胚组),唐氏筛查中孕2319例,新鲜周期胚胎移植647例(中孕鲜胚组),冷冻周期胚胎移植1672例(中孕冻胚组),对照组为经自然受孕单胎孕妇,其中早孕12310例(自然妊娠早孕组),中孕23190例(自然妊娠中孕组)。应用时间分辨荧光法定量检测早中孕期血清生化标记物水平、彩超检测NT厚度值,比较3组孕妇孕早、中期各指标水平及唐氏综合征检出率。结果除了早孕期PAPP-A之外,其他血清标记物水平组间差异均有统计学意义(P<0.05)。经多重比较后发现,早孕期e组游离hCGβ水平差异均有统计学意义(P<0.05),早孕自然妊娠组NT厚度低于冻胚组和鲜胚组冻胚组中孕期hAFP、uE3水平高于鲜胚组和自然妊娠组。自然妊娠组中孕期游离hCGβ水平低于鲜胚组和冻胚组。中孕自然妊娠组21-三体高风险检出率和临界风险检出率高于冻胚组和鲜胚组,中孕冻胚组的NTD高风险检出率高于自然妊娠组,结论新鲜周期胚胎移植妊娠、冷冻周期胚胎移植妊娠与自然妊娠早中孕期唐氏筛查血清标记物水平及检出率有一定的差异,因此可以对不同辅助生殖方式的风险计算进行适当调整,以避免筛查高阳性率,进而减少不必要的侵入性产前诊断。

Objective To investigate the differences in serum marker levels and detection rates of Down’s screening during early and middle trimester of fresh cycle embryo transfer pregnancy,frozen cycle embryo transfer pregnancy and natural pregnancy.Methods A total of 3 550 single pregnant women were screened by assisted reproductive technology( ART),including 1 231 cases of first trimester screening( 338 cases of fresh transfers,893 cases of frozen embryo transfers),and 2 319 cases of second trimester screening( 647 cases of fresh transfers,1 672 cases of frozen embryo transfers). The control group was single pregnant women with natural conception( NAT),including 12 310 cases of first trimester screening( first trimester NAT group) and23 190 cases of second trimester screening( second trimester NAT group). The levels of serum biochemical markers in early and middle pregnancy were quantitatively detected by time-resolved fluorescence method and the NT thickness value was detected by color ultrasound. The levels of various indicators and the detection rate of Down’s syndrome in early and middle pregnancy of the three groups were compared. Results Except for PAPP-A in the first trimester screening,there were significant differences in other serum markers between groups( P < 0. 05). After multiple comparisons,it was found that the level of free h CGβin the three groups of early pregnancy had statistical significance( P < 0. 05),and the thickness of NT in the natural pregnancy group was lower than that in the frozen embryo group and the fresh embryo group. The levels of AFP and UE3 in frozen embryo group were higher than those in fresh embryo group and natural pregnancy group. The level of free h CGβ in natural pregnancy group was lower than that in fresh embryo group and frozen embryo group. The high-risk detection rate of 21 trisomy and critical risk detection rate in the natural pregnancy group were higher than those in the frozen embryo group and the fresh embryo group,and the high-risk detection rate of NTD in the frozen embryo group was higher than that in the natural pregnancy group.Conclusion There are some differences in serum markers and detection rates between pregnancies conceived via fresh and frozen-thawed embryo transfers and those conceived spontaneously in first and middle trimester pregnancy. Therefore,the risk calculation of different assisted reproductive modes can be adjusted properly to avoid high positive rate of screening and reduce unnecessary invasive prenatal diagnosis.