|
|
|
| Screening Efficiency about the First Trimester Screening of PAPP-A Combined with the Second Trimester Screening of AFP for Down's Syndrome |
| FU Jiuyuan, XIAO Yanping, ZHU Yanju, et al |
| The Affiliated Hospital of Chengde Medical College, Hebei Chengde 067000, China |
|
|
|
|
Abstract Objective: To observe the screening effect of the first trimester serum PAPP-A combined with the second trimester serum AFP for Down's syndrome. Methods: A retrospective analysis was made of 1300 pregnant women who underwent prenatal screening and were followed up in the obstetric clinic of our hospital. This study is divided into two programs. First trimester program: Serum PAPP-A and AFP levels were measured during first trimester (10~13+6 weeks). Combined program: Serum PAPP-A levels were measured during first trimester (10~13+6 weeks), and AFP levels were measured during second trimester (15-20+6 weeks).Prenatal screening software Muldeale was used to estimate the risk of Down's syndrome in combination with the age, gestational age, weight, pregnancy history and previous medical history of pregnant women.The high-risk cutoff value of DS is 1/270, and more than 1/270 is high-risk. The screened high-risk pregnant women were given genetic counseling, and the fetal chromosome karyotype was analyzed by diagnostic amniocentesis. The abnormal fetus is selected by the pregnant woman and their family to choose therapeutic abortion. Calculate the positive rate and false positive rate of DS screening for both programs. . Results: The combined program screened 41 high-risk and 81 critical-risk DS patients. In the first trimester program,63 high-risk and 109 critical -risk DS patients were identified. The high risk, critical-risk of DS and total positive rate of screening results of combined program were lower than those of the first trimester program (P < 0.05).6 cases were diagnosed as DS by chromosome karyotype analysis of amniocentesis.5 cases of DS positive in the combined program,the positive rate was 83.3%. 3 cases of DS positive in the first trimester program,the positive rate was 50%. Compared with the two programs, the combined program is better than the first trimester program. Conclusion: The detection of serum PAPP-A in the first trimester combined with serum AFP in the second trimester has a definite effect for Down's syndrome screening. It is worthy of clinical application.
|
|
|
|
|
|
[1] Wulff CB, Gerds TA, Rode L, et al. Risk of fetal loss associated with invasive testing following combined first‐trimester screening for Down syndrome: a national cohort of 147 987 singleton pregnancies[J]. Ultrasound in Obstetrics & Gynecology,2016,47:38~44.
[2] 中华人民共和国卫生部.胎儿常见染色体异常与开放性神经管缺陷的产前筛查与诊断技术标准第一部分:中孕期母血清学产前筛查:WS322.1-2010[M].北京:中国标准出版社,2010.
[3] Agarwal Gupta N,Kabra M.Diagnosis and management of Down syndrome[J].Indian Pediatr,2014,81(6):560~567.
[4] 蒋宇林,刘俊涛,边旭明.唐氏综合征产前筛查指标中位数倍数值中位数的监测和质量评价方法[J].实用妇产科杂志,2014,30(2):84~86.
[5] 张萍,汪吉梅,孟永勤.孕中期血清及超声筛查唐氏综合征临床意义[J].临床儿科杂志,2014,(5):434~437.
[6] Ranta JK, Raatikainen K, Romppanen J, et al. Increased time-to-pregnancy and first trimester Down's syndrome screening[J]. Human reproduction,2009,25:412~417.
[7] 陈益明,褚雪莲,卢莎,等.早孕期母血清PAPP-A联合中孕期二联产前筛查唐氏综合征和开放性神经管缺陷效率[J].中国公共卫生,2018,34(7):961~964.
[8] Chitty LS, Wright D, Hill M, et al. Uptake, outcomes, and costs of implementing non-invasive prenatal testing for Down's syndrome into NHS maternity care: prospective cohort study in eight diverse maternity units[J]. BMJ,2016,354:i3426.
[9] Frank M, Maymon R, Wiener Y, et al. The effect of hereditary versus acquired thrombophilia on triple test down's syndrome screening[J]. Prenatal diagnosis,2013,33: 191~195.
[10] 杨岚,石锦平,吴晓,等.早孕期血清PAPP-A检测联合中孕期血清AFP、freeβ-HCG、uE3检测对DS、ES的筛查效果[J].山东医药,2017,57(35):18~21. |
|
|
|
2019, Vol. 25 
