4771例孕中期妇女唐氏筛查结果分析

Analysis of Down’s screening of 4771 second trimester women

目的探讨孕中期唐氏筛查在产前诊断中的临床应用价值。方法选取2016年1月至2020年12月解放军总医院第七医学中心妇产科门诊产检的4771例妊娠中期(15~20^(+6)周)孕妇,检测孕妇血清中的β-绒毛膜促性腺激素(β-HCG)、甲胎蛋白(AFP)及游离雌三醇(uE3)的水平,并结合孕妇的年龄、体重和孕周等信息,采用上海腾程公司唐氏筛查分析软件系统分析计算神经管缺陷(NTD)、18-三体综合征(简称18-三体)、21-三体综合征(简称21-三体)发生的风险性,对不同年度、不同孕周和不同年龄段筛查孕妇的唐氏筛查高风险率进行统计学比较和分析,同时对4320例唐氏筛查低风险孕妇的激素水平进行分析,评估孕周和体重对血液中AFP、HCG和uE3的浓度的关系。结果所有4771例孕妇中,共筛查出唐氏高风险439例,占总筛查人数9.2%(439/4771);唐氏低风险4320例,占总筛查人数的90.6%。其中,高风险21-三体327例(6.9%),高风险NTD 86例(1.8%),高风险18-三体26例(0.5%)。筛查结果显示,不同年度21-三体高风险率之间差异有无统计学意义(P<0.05),18-三体和NTD高风险率差异无统计学意义(P>0.05);不同孕周(15~19周)发生21-三体的高风险率差异无统计学意义,而发生NTD和18-三体的高风险率差异有统计学意义。不同年龄组高风险率随孕妇年龄增加而显著增加(P<0.05)。4320例唐氏筛查低风险孕妇血液中激素水平分析结果显示,AFP和uE3的浓度随着孕周增加而增加,而HCG浓度随着孕周增加而降低;AFP、HCG和uE3的浓度随孕妇体重增加呈现下降趋势。结论孕中期开展唐氏筛查是一种有效的产前筛查手段,能够评估唐氏综合症患儿出生的风险,具有重要的临床应用价值,应积极倡导孕妇开展孕中期唐氏筛查。

Objective To explore the clinical application value of Down’s Screening in the second trimester of pregnancy in prenatal diagnosis.Methods 4771 pregnant women in the second trimester of pregnancy(15 weeks to 20^(+6)weeks)who sought medical care in the Obstetrics and Gynecology Department of No.7 Medical Center,General Hospital,CPLA from January 2016 to December 2020 were recruited as research subjects.Detections were made in the levels ofβ-chorionic gonadotropin(β-HCG),alpha-fetoprotein(AFP)and free estriol(uE3)in the serum of pregnant women.In the light of such information as age,body weight and gestational weeks,the risk of neural tube defect(NTD),trisomy-18 syndrome(or simply trisomy-18)and trisomy-21 syndrome(or simply trisomy-21)was analyzed and calculated with Down’s syndrome analyzing software(Shanghai Tengcheng).Comparisons and analysis were made concerning the high-risk rate of Down’s screening in the pregnant women at different years,different gestational weeks and different age groups.At the same time,analysis of serum hormone concentration in the 4320 pregnant women with low risk of Down’s screening were performed as well to evaluate the effects of gestational weeks and body weight on the levels of AFP,HCG and uE3.Results Of the 4771 pregnant women screened,439 were identified to have high risk of Down’s syndrome,accounting for 9.2%(439/4771),and 4320 were identified to have low risk of Down’s disease,accounting for 90.6%.Of all the 439 patients with high risk of Down’s syndrome,there were 327 patients with high risk trisomy-21(6.9%),and there were 86 patients with high risk NTD(1.8%)and 26 patients with high risk trisomy-18(0.5%).Screening indicated that there were significant differences in the high risk rates of trisomy-21 for different years(P<0.05).However,no significant differences could be noted in the high risk rates between trisomy-18 and NTD(P>0.05).Significant differences could neither be seen in the risk rates of trisomy-21 at different gestational weeks(15-19 weeks).However,significant differences could be noted in the high risk rates of NTD and trisomy-18.The high risk rates for different age group increased with the increase of age of pregnant women(P<0.05).Analysis of the serum concentrations of4320 pregnant women with low risk of Down’s screening indicated that the levels of AFP and uE3 increased with gestational age,while the concentrations of HCG decreased with the increased gestational age,and the concentrations of AFP,HCG and uE3 decreased with the increase of the body weight of pregnant women.Conclusion Down’s screening in the second trimester of pregnancy is an effective prenatal screening method,which could assess the birth risk of neonates with Down’s syndrome,with important clinical application value.For this reason,pregnant women should be encouraged to have Down’s syndrome screening in the second trimester of pregnancy.