孕中期羊水母体血清甲胎蛋白水平和不良妊娠结局分析.docVIP

孕中期羊水母体血清甲胎蛋白水平和不良妊娠结局分析 　　【摘要】目的了解孕中期羊水母体血清甲胎蛋白（AFP）水平及其与不良妊娠的关系。方法对25 038例孕中期孕妇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中位数倍数（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 　　中图分类号：R714.53文献标识码：ADOI：10.3969/j.issn2015.04.006 　　【Abstract】ObjectiveTo investigate relationship between level of amniotic fluid alphafetoprotein（AFP） in second trimester and adverse pregnancy outcomes.MethodsEnzymelinked immunosorbent assay was used to detect amniotic fluid AFP of 25 038 pregnant women in second trimester.And pregnancy outcomes were followed up.Reference values of amniotic fluid AFP and 2.5 multiple of median（MoM） were established.Results Upper limit of normal amniotic fluid was 15 665.6～28 766.9 ng/ml and 2.5 MoM was 18 712.3～38 694.3 ng/ml during 16～23 weeks of pregnancy，and the values were decreased with the increase of gestational weeks.Proportions of abnormal amniotic fluid AFP were quite high in open neural tube defects，cervical lymphangioma，stillbirth and abdominal abnormality，and proportion of other adverse pregnancy outcomes was relatively，but value of AFP significantly increased.ConclusionAbnormal increase of amniotic fluid AFP is related to the adverse pregnancy outcomes such as neural tube defects，cervical lymphangioma，stillbirth and abdominal abnormality，but some misdiagnosis and missed diagnosis still exist，so ultrasound monitoring is needed to make a definite diagnosis and exclude related malformations. 　　【Key words】amniotic fluid；AFP；adverse pregnancy outcomes 　　母体血清甲胎蛋白（alphafetoprotein，AFP）已被广泛应用于开放性神经管缺陷（open neural tube defects，NTDs）的产前筛查，当母体血清AFP≥2.5中位数倍数（MoM）时采用超声扫描或取羊水检测AFP予以排除或确诊[1～2]。Wald等[3]研究表明羊水AFP异常升高时提示NTDs可能性较大；而以往研究[2，4]表明母体血清或羊水AFP≥2.5 MoM时，胎儿为开放神经管缺陷或其他畸形的确诊率较低，且样本量较少。为此，笔者对2006年1月～2014年6月进行产前诊断的25 038例孕中期孕妇羊水进行AFP检测，并随访妊娠结局，进一步修正