摘要
目的母体血清学产前筛查通过检测母血清中的甲胎蛋白(alpha fetoprotein,AFP)、游离β-人绒毛膜促性腺激素(free-β-human chorionic gonadotropin,Free-β-hcG)及游离雌三醇(unconjugated estriol,uE3)3项指标,发现某些先天缺陷胎儿的高危孕妇。本研究探讨孕期母血清AFP、Free-β-hcG及uE3水平与妊娠结局的关系。方法选取2014-03-01-2016-03-01于潍坊市妇幼保健院检测母血清中AFP、Free-β-hcG与uE3浓度的12 983名孕15～20周孕妇,通过随访追踪孕妇妊娠结局,分析3项血清标记物水平与妊娠结局的关系。结果 AFP、Free-β-hcG和uE33项血清标志物浓度全部正常者12 135例作为对照组,单项或多项血清标记物异常者848例。AFP过高组125例,发生不良妊娠者52例,发生率为41.6%,与对照组比较,胎儿丢失、前置胎盘、胎盘植入的发生率升高,相对危险度(relative risk,RR)分别为7.697、4.072和5.995,差异有统计学意义,均P<0.05;Free-β-hcG过高组144例,发生不良妊娠者44例,发生率为30.6%,与对照组相比,染色体异常、胎盘植入的发生率升高,RR分别为35.123和3.859,差异有统计学意义,P<0.05;uE3过低组143例,发生不良妊娠者37例,发生率为25.9%,与对照组相比,染色体异常的发生率升高,RR为53.438,差异有统计学意义,均P<0.05;多项标记物异常者33例,发生不良妊娠者16例,发生率为48.5%,与对照组相比,胎儿丢失和结构异常的发生率升高,RR分别为11.918和5.904,差异有统计学意义,均P<0.05。结论孕期母血清AFP、Free-β-hcG与uE3水平在临床上可以用于评估及预测妊娠并发症及不良妊娠结局。对于血清标志物异常的孕妇,应密切监测、加强孕中晚期产检,进行胎儿、胎盘监测,防止不良妊娠结局的发生。
OBJECTIVE Maternal serological prenatal screening finds high-risk pregnant women with congenital defect by detecting alpha fetoprotein(AFP),free-beta-human chorionic gonadotropin(free-beta-hcG)and unconjugated estriol(uE3)in maternal serum.The aim of this study is to investigate the relationship between maternal serum AFP,Free-beta-hcG and uE3 levels and pregnancy outcome.METHODS The screening results and obstetric outcomes of those women were collected who received second trimester maternal serum screening in the Weifang Maternal and Child Health Hospital between March 1,2014 and March 1,2016.Normal levels of maternal serum markers as control group,the relationship between serum markers and pregnancy outcome was analyzed.RESULTS A total of 12 983 pregnancies were included in this study,in which 12 135 pregnancies were identified w让h normal levels of all three serum markers and 848 ones with abnormal serum markers.In 125 pregnancies with increased AFP,52 cases presented with adverse outcomes(41.6%).The high level of AFP was significantly associated with fetal demise,placenta praevia and placenta accreta,with relative risk ratios(RR)of 7.697,4.072 and 5.995,respectively.all P<0.05.Among the 144 pregnancies with increased Free-p-hcG.there were 44 cases of adverse outcomes(30.6%).The risk of fetal chromosomal abnormalities and placenta accreta increased with high level of Free-R-hcG,with RR of 35.123 and 3.859,all P<0.05.In 143 pregnancies with increased uE3,37 cases presented with adverse outcomes(25.9%).The high level of uE3 was significantly associated with fetal chromosomal abnormalities and relative risk ratios was 53.438,P<0.05.In the 33 pregnancies with two or more serum markers abnormalities,there were 16 cases with abnormal outcomes(48.5%).The risk of fetal demise and abnormal structure increased,with RR of 11.918 and 5.904,all P<0.05.CONCLUSIONS The maternal serum markers of AFP,Free-p-hcG and uE3 can be used to forecast adverse pregnancy outcomes.Pregnancies with abnormal serum markers should receive close attention and increased detections,in case of adverse outcomes.
作者
孙立宁
路兴军
张胜利
SUN Li-ning;LU Xing-jun;ZHANG Sheng-li(Department of Genetics,Weifang Maternal and Child Health Care Hospital,Weifang 261011,P.R.China)
出处
《社区医学杂志》
2018年第22期1666-1669,1673,共5页
Journal Of Community Medicine
