目的:了解孕中期羊水AFP水平及其与不良妊娠的关系。方法:对孕中期妊娠25,038例羊水采用酶联免疫吸附法进行AFP检测,随访妊娠结局,建立羊水AFP参考值及2.5 MoM。结果:孕16~23 w羊水参考值上限为15,665.6~28,766.9 ng/ml,2.5 MoM为18,712.3~38,694.3 ng/ml,且其值随孕周增加而降低,开放神经管缺陷、颈部淋巴管瘤、死胎和腹部畸形妊娠羊水AFP异常比例较高,其他不良妊娠结局则较低,但其AFP值明显增加。结论:羊水AFP异常升高与神经管缺陷、颈部淋巴管瘤、死胎和腹部畸形等不良妊娠相关,但仍有一定漏诊和误诊,应结合动态超声监测以确诊和排除相关畸形。 Objective: To investigate the level of second trimester amniotic fluid alpha-fetoprotein (AFP) and the relationship between the level of AFP and adverse pregnancy outcomes. Methods: The concen-tration of AFP in amniotic fluid sample from 25,038 second trimester pregnancy women was de-tected by using enzyme linked immunosorbent assay. The outcomes were recorded. Results: The upper limit of reference range and 2.5 MoM of the AFP in different gestational weeks are from 15,665.6 to 28,766.9 ng/ml and from 18,712.3 to 38,694.3 ng/ml, and the level of AFP was high with increasing gestational age. The proportion of abnormal AFP were higher in Neural tube defects (NTDs), cystic hygroma, fetal demise and ventral wall defects (VWDs), and that were low in others, but all of them had abnormal increased AFP value significantly. Conclusion: Levels of AFP correlate with the likelihood of NTDs, cystic hygroma, fetal demise and VWDs. But some pregnancies were misdiagnosed or missed. In order to identify and eliminate related deformities, ultrasound should be needed for further diagnosis.
李东明,黄昌园,周晖登
广西壮族自治区妇幼保健院检验科,广西 南宁
收稿日期:2015年12月2日;录用日期:2015年12月18日;发布日期:2015年12月23日
目的:了解孕中期羊水AFP水平及其与不良妊娠的关系。方法:对孕中期妊娠25,038例羊水采用酶联免疫吸附法进行AFP检测,随访妊娠结局,建立羊水AFP参考值及2.5 MoM。结果:孕16~23 w羊水参考值上限为15,665.6~28,766.9 ng/ml,2.5 MoM为18,712.3~38,694.3 ng/ml,且其值随孕周增加而降低,开放神经管缺陷、颈部淋巴管瘤、死胎和腹部畸形妊娠羊水AFP异常比例较高,其他不良妊娠结局则较低,但其AFP值明显增加。结论:羊水AFP异常升高与神经管缺陷、颈部淋巴管瘤、死胎和腹部畸形等不良妊娠相关,但仍有一定漏诊和误诊,应结合动态超声监测以确诊和排除相关畸形。
关键词 :羊水,甲胎蛋白,不良妊娠结局
母体血清甲胎蛋白(alpha-fetoprotein, AFP)已被广泛应用于开放神经管缺陷(open neural tube defects, NTDs)的产前筛查,当母体血清AFP ≥ 2.5 MoM时采用超声扫描或取羊水检测AFP予以排除或确诊[
2006年1月~2014年6月在本院进行产前诊断的孕妇25,038例,产前诊断指征包括:高龄、母体血清学筛查高风险、地中海贫血高风险和超声异常发现等,排除肿瘤和肝脏疾病等导致母体血清学AFP升高的疾病,年龄18~47岁,平均(28.9 ± 6.4)岁,行羊膜腔穿刺术孕周16~23周。
B超引导下,经腹抽取羊水1~5 ml,2000 r/min离心10 min。样本按1:100稀释后,采用酶联免疫法检测羊水AFP,试剂盒购于瑞典Fujirebio AB公司。按试剂盒说明书进行操作、质量控制及结果判断。异常结果进行复检,结果一致后及时报告临床。电话随访妊娠结局,了解新生儿是否存外观及各组织器官畸形等。计算健康出生妊娠羊水AFP值的MoM值和参考值上限(SI)为±1.645 s。
计量资料采用
25,038例羊水AFP含量为180~191,159 ng/ml,随访妊娠结局,共获得健康出生妊娠羊水AFP值15,968例,经对数概率图、偏度与峰度检验、正态D检验,该资料对数值属正态总体,95%参考值上限(SI)为X ± 1.645 S,见表1。
572例不良妊娠结局羊水AFP结果,按类型以SI为界分为2组,见表2。神经管缺陷、颈部淋巴管瘤、死胎和腹部畸形组AFP > SI的比例较高,AFP ≥ 2.5 MoM,明显高于其他组AFP > SI的比例(χ2 = 245.12, P = 0.00),但两组AFP水平均高于正常组。
以往研究 [
孕周 | n | S | 2.5 MoM | SI | |
---|---|---|---|---|---|
16~ | 432 | 15,424.1 | 4985.3 | 38,694.3 | 28,766.9 |
17~ | 2155 | 14,078.2 | 5458.7 | 35,907.3 | 25,608.2 |
18~ | 3569 | 12,860.6 | 5094.7 | 32,480.5 | 23,178.3 |
19~ | 3962 | 11,536.1 | 4645.3 | 29,473.8 | 21,109.0 |
20~ | 2924 | 10,314.5 | 4506.1 | 26,303.5 | 19,685.5 |
21~ | 1638 | 9297.1 | 4443.6 | 23,303.8 | 18,382.3 |
22~ | 827 | 8368.7 | 4470.9 | 21,204.3 | 17,662.5 |
23~ | 425 | 7356.3 | 3983.4 | 18,712.3 | 15,665.6 |
表1. 各孕周羊水AFP水平及SI
妊娠结局 | AFP < SI | AFP > SI | ||
---|---|---|---|---|
n | n | |||
染色体数目异常 | 127 | 11,771.4 ± 4429.7 | 6 | 40,296.3 ± 16,380.4 |
重型地中海贫血 | 168 | 9956.8 ± 4414.7 | 8 | 31,654.8 ± 9051.5 |
颈部淋巴管瘤 | 3 | 13,816.2 ± 6345.3 | 5 | 89,127.8 ± 52,753.5 |
神经管缺陷 | 2 | 8294 ± 3733.5 | 12 | 76,061.3 ± 33,230.4 |
腹部畸形 | 2 | 16,257 ± 6915.5 | 12 | 43,808 ± 27,233.7 |
其他畸形或异常 | 190 | 10,682.7 ± 4445.0 | 14 | 29,335.4 ± 11,554.9 |
死胎 | 7 | 15,067 ± 7054.5 | 16 | 605,107.7 ± 48,283.0 |
健康 | 15,968 | 11,551.8 ± 4721.6 | 618 | 28,913.5 ± 11,018.4 |
表2. 不良妊娠结局类型及其AFP异常情况
上世纪70年代美国等国家已将血清学筛查高风险孕妇羊水AFP检测作为确诊NTDs的常规检测项目,当羊水AFP ≥ 5 MoM,且羊水胆碱酯酶检测阳性时可以确诊NTDs [
研究 [
总之,羊水AFP异常升高与开放神经管缺陷、颈部淋巴管瘤、腹部畸形和死胎等相关,但影响羊水AFP的因素较多,其水平正常不能排除其可能,临床应进行动态超声监测,以提高诊断的准确性和及时性。
李东明,黄昌园,周晖登. 孕中期羊水AFP水平与不良妊娠结局分析Analysis of the Relationship between the Level of Second Trimester Amniotic Fluid Alpha-Fetoprotein and Adverse Pregnancy Outcomes[J]. 医学诊断, 2015, 05(04): 72-75. http://dx.doi.org/10.12677/MD.2015.54014