CAJ | 학술논문

目的：比较采用辅助生育技术受孕与自然受孕者孕早期唐氏筛查各项指标及筛查假阳性率的差异。方法选取2012年1月-2014年3月在该院进行早期(10~13+6w)唐氏筛查的IVF孕妇1600例,筛选同期孕周、年龄、体重等因素相匹配的自然受孕孕妇16000例为对照组,入选孕妇均为单胎。抽血前B超明确孕周并测量NT,测血清学标志物PAPP-A、fβ-hCG的水平,比较两组各指标中位数的差异及筛查假阳性率。结果各孕周段两组孕妇PAPP-A MoM值均<1.0,IVF组孕妇PAPP-A MoM值低于相应孕周的对照组。两组各孕周段fβ-hCG MoM值均在1.0左右,相应孕周间比较差异无统计学意义。两组孕妇NT水平差异无统计学意义。 IVF组21三体筛查阳性率为13.40%,显著高于对照组10.19%。两组失访率均在8%左右。其中,IVF组206例21三体高风险孕妇中84.5%进行了染色体核型分析,确诊2例；对照组935例中71.5%接受穿刺,确诊15例。两组确诊率相当。IVF组筛查假阳性率为14.69%,明显高于对照组,差异有统计学意义(χ2=7.50,P=0.006)。结论IVF技术的使用会降低早期唐氏筛查血清标志物PAPP-A的浓度,因此增加胎儿21三体检出的假阳性率,建议引入适当的校准系数进行风险评估。
목적：비교채용보조생육기술수잉여자연수잉자잉조기당씨사사각항지표급사사가양성솔적차이。방법선취2012년1월-2014년3월재해원진행조기(10~13+6w)당씨사사적IVF잉부1600례,사선동기잉주、년령、체중등인소상필배적자연수잉잉부16000례위대조조,입선잉부균위단태。추혈전B초명학잉주병측량NT,측혈청학표지물PAPP-A、fβ-hCG적수평,비교량조각지표중위수적차이급사사가양성솔。결과각잉주단량조잉부PAPP-A MoM치균<1.0,IVF조잉부PAPP-A MoM치저우상응잉주적대조조。량조각잉주단fβ-hCG MoM치균재1.0좌우,상응잉주간비교차이무통계학의의。량조잉부NT수평차이무통계학의의。 IVF조21삼체사사양성솔위13.40%,현저고우대조조10.19%。량조실방솔균재8%좌우。기중,IVF조206례21삼체고풍험잉부중84.5%진행료염색체핵형분석,학진2례；대조조935례중71.5%접수천자,학진15례。량조학진솔상당。IVF조사사가양성솔위14.69%,명현고우대조조,차이유통계학의의(χ2=7.50,P=0.006)。결론IVF기술적사용회강저조기당씨사사혈청표지물PAPP-A적농도,인차증가태인21삼체검출적가양성솔,건의인입괄당적교준계수진행풍험평고。
Objective To compare the indexes of first-trimester screening for Down's syndrome and false positive rate of screening between naturally conceived and in vitro fertilization (IVF) pregnancies. Methods From January 2012 to March 2014, a total of 1600 pregnant women conceived by IVF who underwent the first trimester (10~13+6w) Down's syndrome screening were enrolled in this study. 16000 pregnant women conceived naturally matching the IVF pregnant women by gestational age, maternal age, weight were selected as the control group. All pregnancies in the study were singleton. The gestational age was detected by B-ultrasound before blood collection, and NT was measured. And maternal serum PAPP-A and fβ-hCG were measured. The median (MoM) lev-els of the indexes, and the false-positive rate of Down's syndrome screening between the 2 groups were compared. Results PAPP-A MoM were under 1.0 in both groups in each gestational week, and lower in IVF group when compared to the control group in each week. However, fβ-hCG MoM seemed more stable with a median value of 1.0 in both groups in each gestational week with no statistical significance between the groups. There was either no obvious difference between the two groups in the fetal NT. The positive rate of trisomy 21 screening of IVF group was 13.40%, obviously higher than 10.19%of the control group. The lost follow-ing-up rate was about 8% in both groups. Among these, 84.5%of the 206 pregnancies with trisomy 21 high risk in the IVF group accepted chromosome karyotype analysis and 2 cases were confirmed. 71.5% of 935 cases in the control group accepted puncture and 15 cases were finally diagnosed. The rate of confirmed diagnosis was similar in both groups. The false-positive rate of IVF group was 14.69%, significant higher than that of the control group with statistical significance (χ2=7.50, P=0.006). Conclusion Down's syndrome screening of IVF pregnancies had a higher false-positive rate of trisomy 21 than the naturally conceived preg-nancies in the first trimester which mainly caused by the decreased PAPP-A. It's necessary for IVF pregnancies to use proper analyte correction factors in the interpretation of first-trimester Down's syndrome screening results.