摘要
目的探讨血清甲胎蛋白(AFP)、游离雌三醇(uE3)联合三维彩色多普勒超声(3D-CDU)在孕14~18w胎儿神经管畸形(NTD)诊断中的应用价值。方法选取2017年12月至2019年12月于本院行产前检查的孕14~18w的孕妇642例。对所有研究对象进行血清AFP、uE3水平检测及3D-CDU检查。随访调查母亲及胎儿的妊娠结局,NTD胎儿均经引产后外观检查、尸体解剖或出生后跟踪随访等证实,采用羊水细胞培养法对胎儿进行染色体核型分析。分析血清AFP、uE3、3D-CDU诊断NTD的效能,并绘制受试者工作特征曲线分析三者单一与联合检测的诊断价值。结果分娩及引产结果显示,31例为胎儿NTD,检出率为4.83%。血清AFP检测结果显示,42例为胎儿NTD,28例与病理结果相符,漏诊3例,漏诊率为7.14%(3/42),误诊14例,误诊率为33.33%(14/42)。血清uE3检测结果显示,44例为胎儿NTD,26例与病理结果相符,漏诊5例,漏诊率为11.36%(5/44),误诊18例,误诊率为40.91%(18/44)。NTD组、非NTD组、健康组的血清AFP水平依次降低,uE3水平依次升高(P<0.05)。3D-CDU检查结果显示,32例为胎儿NTD,29例与病理结果相符,漏诊2例,漏诊率为6.25%(2/32),误诊3例,误诊率为9.38%(3/32)。三者联合诊断NTD的敏感度、特异度、阳性预测值、阴性预测值分别为96.77%、99.84%、96.77%、99.84%,均高于单一检测方法。AFP、uE3、3D-CDU诊断NTD的AUC分别为0.847(95%CI 0.728~0.965)、0.839(95%CI 0.717~0.960)、0.863(95%CI 0.796~0.929),三者联合诊断NTD的AUC为0.924(95%CI 0.862~0.987)。结论血清AFP、uE3联合3D-CDU对孕14~18w胎儿NTD具有良好的诊断价值,值得临床推广应用。
Objective:To investigate the application value of serum alpha feto-protein(AFP),free estriol(uE3)combined with three-dimensional color Doppler ultrasonography(3D-CDU)in the diagnosis of fetal neural tube defects(NTD)at 14-18 weeks of gestation.Methods:Total of 642 pregnant women with 14-18 weeks of gestation who underwent prenatal examinations in our hospital from December 2017 to December 2019 were selected.The levels of serum AFP,uE3 and 3D-CDU inspections were performed on all subjects.The pregnancy outcome of the mother and fetus was followed up.All NTD fetuses were confirmed by appearance examination after induction of labor,autopsy or follow-up after birth.Amniotic fluid cell culture method was used to analyze the chromosome karyotype of the fetus.The diagnostic efficiency of serum AFP,uE3 and 3D-CDU in NTD was analyzed,and the receiver operating characteristic curve of subjects was drawn to analyze the diagnostic value of single and combined detection of the serum AFP,uE3,3D-CDU.Results:The results of delivery and induced labor showed that 31 cases were fetal NTD,the detection rate was 4.83%.Serum AFP detection results showed that 42 cases were fetal NTD,28 cases were consistent with pathological results,3 cases were missed diagnosis,the missed diagnosis rate was 7.14%(3/42),14 cases were misdiagnosed,and the misdiagnosis rate was 33.33%(14/42).Serum uE3 detection results showed that 44 cases were fetal NTD,26 cases were consistent with pathological results,5 cases were missed diagnosis,the missed diagnosis rate was 11.36%(5/44),18 cases were misdiagnosed,and the misdiagnosis rate was 40.91%(18/44).The levels of serum AFP in NTD group,non NTD group and healthy group were decreased successively,and the level of uE3 in NTD group,non NTD group and healthy group were increased successively,and the differences were statistically significant(P<0.05).3D-CDU examination results showed that 32 cases were fetal NTD,29 cases were consistent with the pathological results,2 cases were missed diagnosis,the missed diagnosis rate was 6.25%(2/32),3 cases were misdiagnosed,and the misdiagnosis rate was 9.38%(3/32).The sensitivity,specificity,positive predictive value,and negative predictive value of serum AFP,uE3 combined with 3D-CDU in the diagnosis of NTD were 96.77%,99.84%,96.77%,and 99.84%respectively,which were all higher than single detection method.The area under the curve(AUC)for the diagnosis of NTD by AFP,uE3,and 3D-CDU were 0.847(95%CI 0.728~0.965),0.839(95%CI 0.717~0.960),0.863(95%CI 0.796~0.929)respectively.The AUC for the diagnosis of NTD by AFP,uE3 combined with 3D-CDU was 0.924(95%CI 0.862~0.987).Conclusion:Serum AFP,uE3 combined with 3D-CDU has good diagnostic value for fetal NTD at 14-18 weeks of gestation,which is worthy of clinical application.
作者
陆海燕
陈万峰
LU Hai-yan;CHEN Wan-feng(Department of Nuclear Medicine,Hai′an People′s Hospital,Jiangsu Province Hai′an City,Jiangsu Province 226600)
出处
《中国优生与遗传杂志》
2020年第12期1511-1513,1538,共4页
Chinese Journal of Birth Health & Heredity
关键词
胎儿神经管畸形
甲胎蛋白
游离雌三醇
三维彩色多普勒超声
诊断价值
Fetal neural tube defects
Alpha feto-protein
Free estriol
Three-dimensional color Doppler ultrasonography
Diagnostic value
