中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2013年
9期
555-560
,共6页
妊娠中期%唐氏综合征%生物学标记%甲胎蛋白类%绒毛膜促性腺激素,β亚单位,人%雌三醇%妊娠结局
妊娠中期%唐氏綜閤徵%生物學標記%甲胎蛋白類%絨毛膜促性腺激素,β亞單位,人%雌三醇%妊娠結跼
임신중기%당씨종합정%생물학표기%갑태단백류%융모막촉성선격소,β아단위,인%자삼순%임신결국
Pregnancy trimester,second%Down syndrome%Biological markers%alpha-Fetoproteins%Chorionic gonadotropin,beta sununit,human%Estriol%Pregnancy outcome
目的 探讨妊娠中期唐氏综合征筛查血清标志物异常与不良妊娠结局的关系.方法 2009年1月1日至2011年1月31日在北京协和医院产科门诊进行妊娠中期三联筛查、在本院分娩并随访到妊娠结局者,共1935例.采用时间分辨荧光免疫分析技术测定妊娠中期(妊娠15～20+6周)孕妇血清甲胎蛋白(alpha fetoprotein,AFP)、游离β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-hCG)及游离雌三醇(unconjugated estriol,uE3)水平.分析血清标志物正常者与异常者之间不良妊娠结局发生率的差异.采用t检验和x2检验进行统计学分析. 结果 (1)1935例孕妇中,血清标志物正常者(正常组)1255例；异常者680例,包括单项异常者577例,2项异常者89例以及3项异常者14例.根据血清标志物异常的情况,将577例单项异常者分为AFP升高组17例、AFP降低组114例、p-hCG升高组242例、β-hCG降低组139例及uE3降低组65例.AFP降低组妊娠中期体重及β-hCG降低组的分娩孕龄大于正常组[分别为(61.3±9.1) kg与(59.5±8.3) kg、(272.6±11.8)d与(274.4±10.1)d,t=2.21和1.99,P均＜0.01].(2)正常组不良妊娠结局发生率为42.8％(537/1255),与血清标志物异常者(43.7％,297/680)相比,差异无统计学意义(RR=1.02,P=0.71).与正常组相比,AFP升高组前置胎盘及胎盘形态异常发生率[分别为25.5％(32/1255)与2/17、4.1％ (51/1255)与5/17,RR=4.61和7.24]、AFP降低组妊娠期糖尿病(gestational diabetes mellitus,GDM)发生率[8.1％(101/1255)与14.4％ (16/114),RR=1.74]、β-hCG升高组胎盘胎膜滞留发生率[3.5％(44/1255)与6.2％(15/242),RR=1.77]及 β-hCG降低组子痫前期发生率[1.7％(21/1255)与6.5％(9/139),RR=3.87]均升高,差异均具有统计学意义(P均＜0.05).(3)血清标志物2项异常者共89例.AFP低β-hCG高组小于胎龄儿、羊水过少和胎盘早剥发生率均高于正常组[小于胎龄儿:6.9％(2/29)与1.8％(22/1255),RR=3.94;羊水过少:20.7％(6/29)与6.4％(80/1255),RR=3.24]；AFP低uE3低组羊水过少发生率高于正常组[3/14与6.4％(80/1255),RR=3.36]；p-hCG低uE3低组早产和GDM发生率高于正常组[早产:2/6与4.3％ (54/1255),RR=7.75;GDM:3/6与8.0％(101/1255),RR=6.21];差异均具有统计学意义(P均＜0.05).(4)血清标志物3项异常者共14例,这些孕妇的血清标志物异常与妊娠不良结局的关系没有统计学意义. 结论 唐氏综合征筛查血清标志物异常与不良妊娠结局有较为密切的关系,妊娠期应密切监测.
目的 探討妊娠中期唐氏綜閤徵篩查血清標誌物異常與不良妊娠結跼的關繫.方法 2009年1月1日至2011年1月31日在北京協和醫院產科門診進行妊娠中期三聯篩查、在本院分娩併隨訪到妊娠結跼者,共1935例.採用時間分辨熒光免疫分析技術測定妊娠中期(妊娠15～20+6週)孕婦血清甲胎蛋白(alpha fetoprotein,AFP)、遊離β-人絨毛膜促性腺激素(β-human chorionic gonadotropin,β-hCG)及遊離雌三醇(unconjugated estriol,uE3)水平.分析血清標誌物正常者與異常者之間不良妊娠結跼髮生率的差異.採用t檢驗和x2檢驗進行統計學分析. 結果 (1)1935例孕婦中,血清標誌物正常者(正常組)1255例；異常者680例,包括單項異常者577例,2項異常者89例以及3項異常者14例.根據血清標誌物異常的情況,將577例單項異常者分為AFP升高組17例、AFP降低組114例、p-hCG升高組242例、β-hCG降低組139例及uE3降低組65例.AFP降低組妊娠中期體重及β-hCG降低組的分娩孕齡大于正常組[分彆為(61.3±9.1) kg與(59.5±8.3) kg、(272.6±11.8)d與(274.4±10.1)d,t=2.21和1.99,P均＜0.01].(2)正常組不良妊娠結跼髮生率為42.8％(537/1255),與血清標誌物異常者(43.7％,297/680)相比,差異無統計學意義(RR=1.02,P=0.71).與正常組相比,AFP升高組前置胎盤及胎盤形態異常髮生率[分彆為25.5％(32/1255)與2/17、4.1％ (51/1255)與5/17,RR=4.61和7.24]、AFP降低組妊娠期糖尿病(gestational diabetes mellitus,GDM)髮生率[8.1％(101/1255)與14.4％ (16/114),RR=1.74]、β-hCG升高組胎盤胎膜滯留髮生率[3.5％(44/1255)與6.2％(15/242),RR=1.77]及 β-hCG降低組子癇前期髮生率[1.7％(21/1255)與6.5％(9/139),RR=3.87]均升高,差異均具有統計學意義(P均＜0.05).(3)血清標誌物2項異常者共89例.AFP低β-hCG高組小于胎齡兒、羊水過少和胎盤早剝髮生率均高于正常組[小于胎齡兒:6.9％(2/29)與1.8％(22/1255),RR=3.94;羊水過少:20.7％(6/29)與6.4％(80/1255),RR=3.24]；AFP低uE3低組羊水過少髮生率高于正常組[3/14與6.4％(80/1255),RR=3.36]；p-hCG低uE3低組早產和GDM髮生率高于正常組[早產:2/6與4.3％ (54/1255),RR=7.75;GDM:3/6與8.0％(101/1255),RR=6.21];差異均具有統計學意義(P均＜0.05).(4)血清標誌物3項異常者共14例,這些孕婦的血清標誌物異常與妊娠不良結跼的關繫沒有統計學意義. 結論 唐氏綜閤徵篩查血清標誌物異常與不良妊娠結跼有較為密切的關繫,妊娠期應密切鑑測.
목적 탐토임신중기당씨종합정사사혈청표지물이상여불량임신결국적관계.방법 2009년1월1일지2011년1월31일재북경협화의원산과문진진행임신중기삼련사사、재본원분면병수방도임신결국자,공1935례.채용시간분변형광면역분석기술측정임신중기(임신15～20+6주)잉부혈청갑태단백(alpha fetoprotein,AFP)、유리β-인융모막촉성선격소(β-human chorionic gonadotropin,β-hCG)급유리자삼순(unconjugated estriol,uE3)수평.분석혈청표지물정상자여이상자지간불량임신결국발생솔적차이.채용t검험화x2검험진행통계학분석. 결과 (1)1935례잉부중,혈청표지물정상자(정상조)1255례；이상자680례,포괄단항이상자577례,2항이상자89례이급3항이상자14례.근거혈청표지물이상적정황,장577례단항이상자분위AFP승고조17례、AFP강저조114례、p-hCG승고조242례、β-hCG강저조139례급uE3강저조65례.AFP강저조임신중기체중급β-hCG강저조적분면잉령대우정상조[분별위(61.3±9.1) kg여(59.5±8.3) kg、(272.6±11.8)d여(274.4±10.1)d,t=2.21화1.99,P균＜0.01].(2)정상조불량임신결국발생솔위42.8％(537/1255),여혈청표지물이상자(43.7％,297/680)상비,차이무통계학의의(RR=1.02,P=0.71).여정상조상비,AFP승고조전치태반급태반형태이상발생솔[분별위25.5％(32/1255)여2/17、4.1％ (51/1255)여5/17,RR=4.61화7.24]、AFP강저조임신기당뇨병(gestational diabetes mellitus,GDM)발생솔[8.1％(101/1255)여14.4％ (16/114),RR=1.74]、β-hCG승고조태반태막체류발생솔[3.5％(44/1255)여6.2％(15/242),RR=1.77]급 β-hCG강저조자간전기발생솔[1.7％(21/1255)여6.5％(9/139),RR=3.87]균승고,차이균구유통계학의의(P균＜0.05).(3)혈청표지물2항이상자공89례.AFP저β-hCG고조소우태령인、양수과소화태반조박발생솔균고우정상조[소우태령인:6.9％(2/29)여1.8％(22/1255),RR=3.94;양수과소:20.7％(6/29)여6.4％(80/1255),RR=3.24]；AFP저uE3저조양수과소발생솔고우정상조[3/14여6.4％(80/1255),RR=3.36]；p-hCG저uE3저조조산화GDM발생솔고우정상조[조산:2/6여4.3％ (54/1255),RR=7.75;GDM:3/6여8.0％(101/1255),RR=6.21];차이균구유통계학의의(P균＜0.05).(4)혈청표지물3항이상자공14례,저사잉부적혈청표지물이상여임신불량결국적관계몰유통계학의의. 결론 당씨종합정사사혈청표지물이상여불량임신결국유교위밀절적관계,임신기응밀절감측.
Objective To investigate the relationship between abnormalities of maternal serum markers in Down syndrome screening in second trimester and adverse pregnancy outcome.Methods Totally,1935 pregnant women were screened for Down syndrome with maternal serum tri marker with time-resolved fluorescence assay,including alpha fetoprotein (AFP),free β-human chorionic gonadotropin (β-hCG) and unconjugated estriol (uE3),between 15 and 20+6 gestational weeks at Peking Union Hospital from January 1,2009 to January 31,2011,and were followed up till delivery.The relationship between incidence of adverse pregnancy outcomes and women with normal or abnormal levels of serum markers in Down syndrome screening was investigated.T-test or Chi-square test were applied for statistical comparison.Results (1) Among the 1935 pregnant women,normal levels of serum markers were found in 1255(normal group) and 680 were abnormal(abnormal group),in which 577 with only one abnormal serum marker,89 with two and 14 with three abnormal serum markers.According to the serum marker level,the 577 women with one abnormal serum marker were further divided into five groups,including high AFP group (n=17),low AFP group (n=114),high β-hCG group (n=242),low β-hCG group (n=139) and low uE3 group (n=65).The birth weight of infants in lower AFP group and the gestational age at delivery in low β-hCG group were greater than those in normal group [(61.3±9.1) kg vs (59.5±8.3) kg,(272.6±11.8) d vs (274.4±10.1) d,t=2.21 and 1.99,both P＜0.01].(2) The incidence of adverse pregnancy outcome in normal group was 42.8％(537/1255),while comparing with the abnormal group(43.7％,297/680),no statistical significance was shown (RR =1.02,P =0.71).While comparing with the normal group,the incidences of placenta previa [25.5％ (32/1255) vs 2/17,RR=4.61,P＜0.05] and abnormal placental morphology were higher in high AFP group [4.1％ (51/1255) vs 5/17,RR=7.24,P＜ 0.05],the incidence of gestational diabetes mellitus (GDM) was higher in low AFP group [8.1％ (101/1255) vs 14.4％(16/114),RR=1.74,P＜0.05],the incidence of placenta and membrane retention was higher in high β-hCG group [3.5％ (44/1255) vs 6.2％(15/242),RR=1.77,P＜0.05],the incidence of pre-eclampsia was higher in low β-hCG group [1.7％ (21/1255) vs 6.5％ (9/ 139),RR=3.87,P＜0.05].(3) There were 89 women with two abnormal serum markers.Comparing with the normal group,the incidences of small for gestional age (SGA) infants,oligohydramnios,abruptio placenta were higher in women with low AFP but high β-hCG [SGA infants:6.9％(2/29) vs 1.8％(22/1255),RR=3.94; oligohydramnios:20.7％(6/29) vs 6.4％(80/ 1255),RR=3.24; both P＜0.05],the incidences of oligohydramnios was higher in women with both low AFP and low uE3[3/14 vs 6.4％(80/1255),RR=3.36,P＜0.05],the incidence of premature birth and GDM were higher in women with both low β-hCG and low uE3 [premature birth:2/6 vs 4.3％(54/1255),RR=7.75; GDM:3/6 vs 8.0％ (101/1255),RR=6.21; both P＜0.05].(4) There were 14 women with three abnormal serum markers.The relationship between adverse outcome and abnormal serum markers did not show any statistical significance.Conclusions The abnormality of serum markers of Down syndrome screening is closely related to adverse pregnancy outcomes,and women with abnormal serum markers should be carefully monitored during pregnancy.
