孕早期NT测量联合中孕血清AFP及hCG检测用于产前筛查的作用

摘要

目的 分析孕早期胎儿颈透明层(NT)测量联合中孕血清甲胎蛋白(AFP)和人绒毛膜促性腺激素(hCG)检测用于产前筛查的作用.方法 随机抽取2015年7月1日至2016年10月31日在海南西部中心医院进行初次产检建册及复诊的单胎妊娠孕妇共1 339例,孕早期进行NT检测,孕中期血清学检测AFP、β-hCG,观察比较单独NT检测、单独血清学检测和联合检测的结果.结果 孕早期NT高危52例,孕中期血清学检测高危92例,孕早期NT检测和孕中期血清学检测同时高危23例,胎儿核型染色体确诊唐氏综合征2例,18-三体综合征1例,心脏畸形1例,其他异常2例.单项超声检测NT厚度、单项母体血清学检测及联合检测阳性率比较差异无统计学意义(P＞0.05),胎儿异常检出率比较差异有统计学意义(x2=6.6832,P＜0.05).联合筛查胎儿唐氏综合征及胎儿异常的特异性、敏感性明显高于单项检查.结论 早孕NT联合中孕期血清学筛查提高了唐氏综合征的检出率.%Objective To analyze the effect of fetal nuchal translucency (NT) measurement in early pregnancy combined with serum alpha fetoprotein (AFP) and human chorionic gonadotropin (hCG) detection in middle pregnancy on prenatal screening.Methods Altogether 1 339 cases of singleton pregnancy who put on record at first pregnancy check-up and rechecked in Hainan West Central Hospital from July 1 in 2015 to October 31 in 2016 were randomly selected and examined with NT measurement in early pregnancy,serum AFG,β-hCG detection in middle pregnancy or combined detection.Results acquired from NT detection alone,serum detection alone and combined detection were observed and compared.Results Fifty-two high risk cases were found by NT measurement in early pregnancy,92 high risk cases were found through serum tests in middle pregnancy and 23 high risk cases were found by combined tests.Two cases of Down' s syndrome,1 case of trisomy 18,1 case of cardiac malformation,and 2 cases of other abnormalities were diagnosed through fetal chromosome examination.Difference in positive rate of NT thickness ultrasonic examination,maternal serum examination and combined examination had no statistical significance (P ＞ 0.05),but difference in abnormality detection rate of three examination ways was statistically significant (x2 =6.6832,P ＜ 0.05).Specificity and sensitivity of combined examination were greatly higher than those of single check in screening Down' s syndrome and fetal abnormalities.Conclusion Combined screening of NT examination in early pregnancy and serum test in middle pregnancy increases detection rate of Down' s syndrome.