早孕期血清游离人绒毛膜促性腺激素、妊娠相关血浆蛋白A检测预测21-三体综合征的临床意义

Clinical significance of serum free human chorionic gonadotropin and pregnancy-associated plasma protein A in early pregnancy prediction of trisomy 21 syndrome

目的观察早孕期唐氏筛查中21-三体综合征(DS)不同风险产妇的血清游离人绒毛膜促性腺激素(Free-β-HCG)、妊娠相关血浆蛋白A(PAPPA)水平,分析Free-β-HcG、PAPPA水平预测DS高风险的价值。方法回顾性分析2018年1月-2019年12月本院早孕期唐氏筛查检出的DS高风险产妇的临床资料,从中筛选出符合条件的208例作为研究对象,DS组无DS组,另选同期早孕期唐氏筛查结果正常的产妇作为对照组。对比3组产妇的血清Free-β-HCG、PAPPA水平,采用双变量Pearson直线相关性分析检验DS高风险产妇血清Free-β-HCG、PAPPA水平间的关系。结果DS组产妇的Free-β-HCG水平最高、PAPPA水平最低,无DS组次之,对照组的Free-β-HCG水平最低、PAPPA水平最高,3组间差异有统计学意义(P<0.05);双变量Pearson直线相关性分析显示,DS高风险产妇的血清Free-β-HCG水平与PAPPA水平呈负相关(r=-0.855,P<0.05);血清Free-β-HCG、PAPPA水平预测DS发生的曲线下面积(AUC)分别为0.775、0.796,均>0.75,有一定预测价值。结论早孕期唐氏筛查检出的DS高风险产妇,若其血清Free-β-HCG过表达或(和)PAPPA水平低表达,可能预示DS风险极高,临床应重视这类产妇进一步DS筛查的严密性、严谨性及准确性,以减少漏诊发生。

Objective To observe the levels of free human chorionic gonadotropin(Free-β-HCG)and pregnancy-associated plasma protein A(PAPPA)in pregnant women with different risk ratio of first-trimester Down syndrome(DS)screening,and to analyze the value of Free-β-HCG and PAPPA levels in predicting the high risk of DS.Methods The clinical data of pregnant women with high-risk DS in first-trimester DS screening in the hospital from January 2018 to December 2019 were retrospectively analyzed.208 eligible cases were selected as DS group and non-DS group,and the pregnant women with normal results of first-trimester DS screening during the same period were selected as control group.The serum Free-β-HCG and PAPPA levels of the three groups were compared,and the relationship between serum Free-β-HCG and PAPPA levels of highrisk DS pregnant women was tested by bivariate Pearson linear correlation analysis.The receiver operating characteristic curve(ROC)was drawn to test the predictive value of serum Free-β-HCG and PAPPA levels in predicting DS.Results The level of Free-β-HCG in DS group was the highest,and the level of PAPPA was the lowest,followed by DS-free group,and the level of Free-β-HCG in control group was the lowest,and the level of PAPPA was the highest,and the differences among the three groups were statistically significant(P<0.05);Bivariate Pearson linear correlation analysis showed that serum Free-β-HCG levels of high-risk DS pregnant women were negatively correlated with PAPPA levels(r=-0.855,P<0.05);the area under the curve(AUC)of serum Free-β-HCG and PAPPA levels in predicting the occurrence of DS was 0.775 and0.796,respectively,both of which were greater than 0.75,which had certain predictive value.Conclusion For high-risk DS pregnant women in first-trimester DS screening,over-expression of serum Free-β-HCG or-(and)low expression of PAPPA may indicate the very high risk of DS.Clinical attention should be paid to the rigor,preciseness,and accuracy of further DS screening for such pregnant women,so as to reduce the incidence of missed diagnosis.