母血甲胎蛋白结合彩色多普勒超声对孕期胎儿神经管畸形的筛查价值

The significance of detection of maternal blood alpha-fetoprotein combined with color Doppler ultrasound in screening of fetal neural tube defects during pregnancy

目的探讨母血甲胎蛋白结合彩色多普勒超声用于孕期胎儿神经管畸形筛查的价值。方法选取2016年3月至2018年3月就诊的650例孕妇为研究对象,进行母血甲胎蛋白检测和彩色多普勒超声检查,对比两种方法在孕期胎儿神经管畸形筛查的准确率。结果650例孕妇中,甲胎蛋白检查显示高危孕妇20例(3.08%),经彩色多普勒超声检查阳性者23例(3.54%),高危产妇中超声检查阳性17例,阳性率85.00%,低危产妇超声检查阳性6例,阳性率0.95%;高危产妇神经管畸形阳性率明显高于低危产妇,差异有统计学意义(P<0.05)。650例孕妇经彩色多普勒超声检查胎儿畸形23例,其中无脑儿10例,脑积水7例,脑膜膨出3例,脊椎裂3例。引产后尸检均得到证实;以MRI诊断结果作为金标准,母血甲胎蛋白联合彩色多普勒超声诊断的灵敏度、特异度发现,联合检测的灵敏度、特异度分别为86.96%,61.72%。结论母血甲胎蛋白结合彩色多普勒超声可显著提高孕期胎儿神经管畸形检出的准确率,具有较高的安全性,值得推广。

Objective To investigate the significance of detection of maternal blood alpha-fetoprotein combined with color Doppler ultrasound in screening of fetal neural tube defects during pregnancy.Methods A total of 650 pregnant women who visited our hospital from March 2016 to March 2018 were enrolled in the study,who underwent maternal blood alpha-fetoprotein detection and color Doppler ultrasonography.The accuracy of the two methods in diagnosis of fetal neural tube malformation during pregnancy was observed and compared.Results Of the 650 pregnant women,there were 20 cases(3.08%)of high-risk pregnant women revealed by alpha-fetoprotein examination,of whom,23 cases(3.54%)were positive by color Doppler ultrasound,and 17 cases were positive in high-risk parturients,with positive rate being 85%.There were 6 high-risk parturients by ultrasound examinations,with positive rate being 0.95%.The positive rate of neural tube malformation in high-risk puerpera was significantly higher than that of low-risk puerpera(P<0.05).Of the 650 pregnant women who were examined by color Doppler ultrasound,there were 23 cases of neural tube malformation,including 10 cases of anencephaly,7 cases of hydrocephalus,3 cases of meningocele,and 3 cases of spina bifida.MRI diagnosis results were taken as gold standard,the sensitivity and specificity of combined detection were 86.96%and 61.72%,respectively.Conclusion The maternal blood alpha-fetoprotein detection combined with color Doppler ultrasound examination can significantly improve the accuracy of diagnosis of neural tube malformation during pregnancy,with higher safety,thus,it is worthy of clinical promotion.