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目的研究高龄孕妇(≥35岁)血清学筛查唐氏综合征的价值,以期减少羊膜腔穿刺的几率,避免医源性流产。方法对在复旦大学附属妇产科医院产检的10601名中期妊娠孕妇进行唐氏综合征的血清学筛查,采用血清学三联指标,即绒毛膜促性腺激素、非结合雌三醇、甲胎蛋白。通过Beckman公司的放射免疫仪测定计算上述三项指标的MoM值和唐氏综合征的患病风险。以1/380为切割值,并随访所有孕妇的妊娠结局。结果从2007年6月～2009年12月,共有10601名在复旦大学附属妇产科医院产检的适龄孕妇进行唐氏综合征的血清学筛查,高风险孕妇有899例,总的阳性率为8.48%。其中高龄孕妇有777例,其高风险例数有268例,阳性率为34.49%,明显高于年龄低于35岁的阳性风险率,后者为6.42%。在随访结果中,共有9例唐氏儿,其中4例为高龄孕妇所生。这4例唐氏综合征的血清学检查结果均为高风险,高龄孕妇的血清学筛查阴性结果中,没有出现唐氏儿。结论对于高龄孕妇,血清学筛查可作为第一线筛查手段,应与孕妇及家属探讨产前筛查的方法及各自利弊,由孕妇及家属决定是否直接接受羊膜腔穿刺。
Objective To study the value of serum screening for Down’s syndrome in pregnant women (≥35 years old) in order to reduce the risk of amniocentesis and avoid iatrogenic abortion. Methods A total of 10 601 pregnant women of the second trimester were enrolled in the obstetrics and gynecology hospital affiliated to Fudan University to carry out serological screening of Down’s syndrome. Serological triple indices of chorionic gonadotropin, unconjugated estriol, . The MoM values of these three indicators and the risk of Down’s syndrome were calculated by Beckman’s radioimmunoassay. Cut at 1/380, and follow up all pregnant women’s pregnancy outcomes. Results From June 2007 to December 2009, a total of 10,601 pregnant women of the same age who were examined at Fudan University Obstetrics and Gynecology Hospital underwent serological screening of Down syndrome. There were 899 high-risk pregnant women with the total positive rate 8.48%. Among them, 777 pregnant women with advanced age had 268 cases of high risk, the positive rate was 34.49%, which was significantly higher than the positive risk rate of younger than 35 years old, the latter was 6.42%. In the follow-up results, a total of 9 Down’s children, of which 4 were born pregnant women. The 4 cases of Down Syndrome serological test results are high risk, serological screening of pregnant women negative results, did not appear Down’s children. Conclusions Serum screening can be used as a first line screening method for advanced pregnant women. Methods of prenatal screening and their respective advantages and disadvantages should be explored with pregnant women and their families. The pregnant women and their families decide whether they should receive amniocentesis directly.