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目的探讨游离雌三醇(unconjugated estriol,uE3)在孕中期唐氏综合征筛查中的应用价值。方法采用时间荧光分辨免疫法测定孕中期母血清中甲胎蛋白(AFP)、游离人绒毛促性腺激素β亚单位(Free-β-hCG)和游离雌三醇水平,再采用随机配套的Wallac 2T专用风险评估软件进行数据分析,比较二联(AFP、Free-β-hCG)和三联(AFP、Free-β-hCG和uE3)唐氏综合征(Down’s Syndrome,DS)筛查的检出率和假阳性率以评价uE3在DS筛查中的应用价值。结果通过对绍兴妇保院2010年1月~2012年12月50 188例孕中期孕妇进行产前筛查,筛查阳性检出DS 19例,漏诊7例,DS发病率1/1930;以1/270为阳性截断值,DS三联和二联筛查方案的检出率分别为73.08%、61.54%,检出率没有明显提高,统计学上无显著差异(χ2=0.79,P>0.05);DS三联和二联的筛查假阳性率分别为2.53%和4.15%,三联假阳性率明显低于二联(χ2=204.18,P<0.01)。结论孕中期在DS二联筛查的基础上增加uE3指标,能一定程度上提高DS检出率,能明显降低假阳性率,具有广泛的应用价值。
Objective To investigate the value of unconjugated estriol (uE3) in the screening of Down’s syndrome in the second trimester of pregnancy. Methods The levels of AFP, Free-β-hCG and free estriol in the second trimester maternal serum were determined by time-fluorescence-resolved immunosorbent assay (ELISA), and then randomly assigned to Wallac 2T Data was analyzed using a proprietary risk assessment software to compare the detection rates of Down’s Syndrome (DS) screening with AFP, Free-β-hCG and triple AFP (Free-β-hCG and uE3) False positive rate to evaluate the value of uE3 in DS screening. Results A total of 50 188 pregnant women of the second trimester of pregnancy from January 2010 to December 2012 in Shaoxing were enrolled in this study. Among them, 19 were DS positive, 7 were missed, and the incidence of DS was 1/1930. / 270 was positive. The detection rates of DS triple and double screens were 73.08% and 61.54%, respectively. The detection rate did not increase significantly (χ2 = 0.79, P> 0.05). DS triple and double screening false positive rates were 2.53% and 4.15%, triple false positive rate was significantly lower than the second couple (χ2 = 204.18, P <0.01). Conclusion In the second trimester of pregnancy, adding uE3 index based on DS double screening can improve the detection rate of DS to a certain extent, and can significantly reduce the false positive rate, which has a wide range of application value.