CAJ | 학술논문

目的：探讨孕妇血清妊娠相关蛋白(PAPP)-A 与解整合素-金属蛋白酶(ADAM)12在早孕期产前筛查中的运用。方法收集2010年5月至2012年7月于甘肃省妇幼保健院产前诊断中心门诊就诊并自愿接受早孕期产前筛查孕妇的静脉血血清标本1609份为研究对象,其年龄为19~45岁,孕龄为9~13+6孕周(本研究遵循的程序符合甘肃省妇幼保健院人体试验委员会制定的伦理学标准,得到该委员会批准,并征得受试对象的知情同意)。各孕周孕妇的年龄和体质量比较,差异无统计学意义(P>0.05)。采用 Auto-DELFIA 全自动时间分辨荧光免疫分析仪、ADAM12、PAPP-A 和游离β-人绒毛膜促性腺激素(hCG)试剂盒,检测早孕期孕妇血清 ADAM12、PAPP-A 和游离β-hCG的水平,并采用 Lifecycle 3.0产前筛查软件评估 ADAM12、PAPP-A 和游离β-hCG 水平及其与唐氏综合征(DS)、开放性神经管缺陷(ONTD)、18-三体综合征等不良妊娠结局的关系。结果本组1609例孕妇的血清游离β-hCG、PAPP-A和ADAM12水平随孕周延长而升高,相关系数呈显著相关,且差异均有统计学意义(r=0.9552,0.9933,0.9965；P<0.05)。将血清PAPP-A、游离β-hCG和ADAM12分别进行直线回归分析结果显示,早孕期血清游离β-hCG、PAPP-A和 ADAM12水平具有较强的正相关关系(血清游离β-hCG vs.血清 PAPP-A,r=0.9490,P<0.05；血清游离β-hCG vs.血清 ADAM12,r=0.9440,P<0.05；血清 ADAM12 vs.血清PAPP-A,r=0.9770,P<0.05)。此外,1609例孕妇中,染色体核型异常为11例(0.68%),其中45,XO 为4例(0.25%)、DS为3例(0.19%)、神经管畸形为2例(0.12%)、18-三体综合征为1例(0.06%)、13-三体综合征为1例(0.06%)。DS高风险孕妇血清 PAPP-A 和 ADAM12中位数倍数(MoM)均低于正常孕妇。结论血清PAPP-A和 ADAM12可作为早孕期产前筛查染色体异常的指标之一。
목적：탐토잉부혈청임신상관단백(PAPP)-A 여해정합소-금속단백매(ADAM)12재조잉기산전사사중적운용。방법수집2010년5월지2012년7월우감숙성부유보건원산전진단중심문진취진병자원접수조잉기산전사사잉부적정맥혈혈청표본1609빈위연구대상,기년령위19~45세,잉령위9~13+6잉주(본연구준순적정서부합감숙성부유보건원인체시험위원회제정적윤리학표준,득도해위원회비준,병정득수시대상적지정동의)。각잉주잉부적년령화체질량비교,차이무통계학의의(P>0.05)。채용 Auto-DELFIA 전자동시간분변형광면역분석의、ADAM12、PAPP-A 화유리β-인융모막촉성선격소(hCG)시제합,검측조잉기잉부혈청 ADAM12、PAPP-A 화유리β-hCG적수평,병채용 Lifecycle 3.0산전사사연건평고 ADAM12、PAPP-A 화유리β-hCG 수평급기여당씨종합정(DS)、개방성신경관결함(ONTD)、18-삼체종합정등불량임신결국적관계。결과본조1609례잉부적혈청유리β-hCG、PAPP-A화ADAM12수평수잉주연장이승고,상관계수정현저상관,차차이균유통계학의의(r=0.9552,0.9933,0.9965；P<0.05)。장혈청PAPP-A、유리β-hCG화ADAM12분별진행직선회귀분석결과현시,조잉기혈청유리β-hCG、PAPP-A화 ADAM12수평구유교강적정상관관계(혈청유리β-hCG vs.혈청 PAPP-A,r=0.9490,P<0.05；혈청유리β-hCG vs.혈청 ADAM12,r=0.9440,P<0.05；혈청 ADAM12 vs.혈청PAPP-A,r=0.9770,P<0.05)。차외,1609례잉부중,염색체핵형이상위11례(0.68%),기중45,XO 위4례(0.25%)、DS위3례(0.19%)、신경관기형위2례(0.12%)、18-삼체종합정위1례(0.06%)、13-삼체종합정위1례(0.06%)。DS고풍험잉부혈청 PAPP-A 화 ADAM12중위수배수(MoM)균저우정상잉부。결론혈청PAPP-A화 ADAM12가작위조잉기산전사사염색체이상적지표지일。
Objective To discuss the application of pregnancy-sociated plasma protein (PAPP)-A, disintegrin-metalloproteinase (ADAM)1 2 in prenatal screening during first trimester.Methods A total of 1 609 samples which were collected from pregnant women receiving prenatal screening in the first trimester in Gansu Provincial Maternity and Child-Care Hospital from May 2010 to July 2012 were included into this study.Their age ranged from 18 to 45 years old,and gestational age ranged from 9 to 13+6 gestational weeks.Auto-DELFLA were used to test the levels of serum ADAM 12,PAPP-A and free β-human chorionic gonadotrophin(hCG),then the results were analyzed by LifeCycle 3.0 risk assessment software. Furthermore,the relationship between fetal risks [Down syndrome (DS ), open neural tube defect (ONTD),trisomy 18 syndrome]and levels of ADAM12,PAPP-A,freeβ-hCG were detected.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Gansu Provincial Maternity and Child-Care Hospital.Informed consent was obtained from each participants′ parents. Results Among the 1 609 samples,the levels of free β-hCG,PAPP-A and ADAM12 increased with gestational age. The related indexes of serum free β-hCG, PAPP-A and ADAM1 2 showed positive correlations with gestational weeks (r=0.955 2,0.993 3,0.996 5;P<0.05 ).The results of linear regression analysis among serum freeβ-hCG,PAPP-A and ADAM1 2 showed strong positive correlation (freeβ-hCG vs.PAPP-A,r=0.949 0,P<0.05;freeβ-hCG vs.ADAM12,r=0.944 0,P<0.05;ADAM12 vs.PAPP-A,r=0.977 0,P<0.05 ).In addition,of the 1 609 samples,eleven cases (0.68%)had chromosome abnormalities,including four cases of 45,XO (0.25%),three cases of DS (0.19%),two cases of neural tube defects (0.12%),one case of 18-trisomy syndrome (0.06%),one case of 13-trisomy syndrome (0.06%).The multiples of median (MoM)levels of serum PAPP-A and ADAM12 were lower than those of normal chromosome pregnant women.Conclusions Serum PAPP-A and ADAM1 2 could be used as indicators of prenatal screening for chromosomal abnormalities during the first trimester.