血清AFP、FA、HCY水平辅助NT超声在产前筛查胎儿神经管畸形中的作用分析

Analysis of the role of serum AFP,FA and HCY levels in assisting NT ultrasound in prenatal screening for neural tube malformations in fetuses

目的:探讨血清学相关标志物水平辅助颈项透明层(Nuchal translucency thickness,NT)超声检测于产前筛查胎儿神经管畸形的应用价值。方法:选取我院2021年3月至2023年2月期间产检孕妇114例作为研究对象,均行NT超声检查以及血清甲胎蛋白(Alpha fetoprotein,AFP)、叶酸(Folic acid,FA)、同型半胱氨酸(Homocysteine,HCY)检查。以引产结果作为判断神经管畸形的金标准。分析对比无神经管畸形、有神经管畸形者血清AFP、FA、HCY水平变化以及NT水平;分析NT、AFP、FA、HCY对胎儿神经管畸形的预测价值以及不同水平时胎儿发生神经管畸形的危险度。结果:114例引产产妇中,胎儿发生神经管畸形者27例,未发生神经管畸形者87例。神经管畸形者NT、血清HCY、AFP水平高于无神经管畸形者,血清FA水平低于无神经管畸形者(P<0.05)。受试者工作特征(Receiver operating characteristic curve,ROC)曲线,结果显示,NT、血清HCY、AFP、FA水平检查胎儿神经管畸形的曲线下面积(Area under curve,AUC)值为0.806,最佳诊断敏感度为81.48%、特异度为86.21%,明显优于单一指标(P<0.05);危险度分析显示,高水平AFP、FA、HCY发生胎儿神经管畸形为低水平的6.191倍、7.265倍、0.118倍、6.475倍(P<0.05)。结论:血清AFP、FA、HCY水平辅助NT诊断胎儿神经管畸形的效果明显,此外,不同水平的胎儿发生神经管畸形危险度存在差异,可作为临床早期筛查胎儿神经管畸形方式之一。

Objective:To investigate the value of ultrasound detection of Nuchal translucency thickness(NT)with serological markers in prenatal screening for neural tube malformations in fetus.How:A total of 114 pregnant women with prenatal check-up in our hospital from March 2021 to February 2023 were selected as the study subjects.All of them received NT ultrasound examination and serum alpha fetoprotein(AFP),Folic acid(FA)and Homocysteine.(HCY)examination.The result of induced labor is the gold standard to judge neural tube malformation.The serum levels of AFP,FA,HCY and NT were compared between those without neural tube malformations and those with neural tube malformations.The predictive value of NT,AFP,FA and HCY for neural tube malformation and the risk of neural tube malformation at different levels were analyzed.Results:Among 114 cases of induced labor,27 cases had neural tube malformation and 87 cases did not.The levels of NT,HCY and AFP in the patients with neural tube malformation were higher than those without neural tube malformation,and the levels of FA in the patients with neural tube malformation were lower than those without neural tube malformation(P<0.05).Receiver operating characteristic curve(ROC)curve,the results showed that NT,serum HCY,AFP,FA levels to detect fetal neural tube malformation Area under curve,The value of AUC was 0.806,the best diagnostic sensitivity was 81.48%,and the specificity was 86.21%,which was significantly better than that of single index(P<0.05).Risk analysis showed that the incidence of fetal neural tube malformations with high levels of AFP,FA and HCY was 6.191 times,7.265 times,0.118 times and 6.475 times more than that with low levels(P<0.05).Conclusion:Serum AFP,FA and HCY levels are effective in assisting NT in the diagnosis of fetal neural tube malformations.In addition,different levels of fetal neural tube malformations have different risks,which can be used as one of the early screening methods for fetal neural tube malformations.