Study On The Role Of Inhibin A In Down’s Screening

Down syndrome is a chromosomal abnormality caused by an extra chromosome 21 in the body of a child.Most children have miscarriages in the early stages of pregnancy,while a small number of survivors have clinical manifestations of multiple deformities,mental retardation,and special facial features.At present,there is no effective treatment for Down-syndrome.Prenatal screening is the most effective way of prevention,which can intervene in high-risk groups in advance to improve the birth quality of the population.For many years,domestic screening for Down-syndrome has mainly been carried out by detecting serum indicators of pregnant women,such as free estriol(Free estriol uE3),human chorionic gonadotropin(Human chorionic gonadotropin HCG)and alpha-fetoprotein(Alpha fetoprotein AFP).The positive detection rate of the triple screening program can reach 69%～77%,which is of great significance for the diagnosis of the disease.However,some studies have shown that adding inhibin A(quadruple screening)to the triple screening can increase the detection rate by 8%to 80%,while the false positive rate can also be reduced by 30%～60%.In recent years,with the development of inhibin A immunoassay technology,quadruple screening has become possible.Although there are many reports about the involvement of inhibin A in the screening of Down-syndrome in the second trimester of pregnancy,there are few domestic related studies.Based on this study,this study explores the use of inhibin A in prenatal screening,and aims to provide a theoretical basis for prenatal screening for Down-syndrome.[Object]To explore the application value of serum statin A in the screening of Down’s disease,and establish the reference range of serum statin A in 15～20+6 weeks single fetus in this region,so as to provide basic data for the inclusion of statin A in prenatal examination in China.[Methods]1.Retrospective analysis of 16452 pregnant women who received Downsyndrome screening from April 2019 to December 2020 in our hospital’s prenatal examination center.Among all the study subjects,16422 fetuses were normal and 30 fetuses with Down-syndrome.Thirty fetuses with Down-syndrome were included in the Down-syndrome group,and matched according to the gestational age and age of the pregnant mother.Among 16422 healthy pregnant women,84 pregnant women with normal obstetrics were matched as the normal group.2.Use time-resolved fluorescence technology to detect the levels of pregnant women’s serum β-hCG,uE3,AFP,and Inhibin-A.The median multiple(Median multiple MOM)is obtained by taking the ratio of the detection value of each index to the median value of the corresponding detection value of pregnant women in the same gestational week.The MOM values were corrected in the comprehensive maternal weight,age,and gestational age.Then the data is imported into the 2T-Risks Down’s risk calculation software for processing,and finally the Down-syndrome risk value is analyzed through the structure of weight and median.In this study,1/270 was used as the positive cut-off value of Down-syndrome risk.3.Use receiver operating characteristic(ROC)curve to evaluate and compare the curve to evaluate and compare β-hCG+AFP dual screening,inhibin A+β-hCG+uE3+AFP quadruple screening,and β-hCG+uE3+AFP triple screening The predictive value of Down-syndrome diagnosis.4.Use pearson correlation to analyze the correlation between Inhibin-A and β-hCG,uE3 and AFP.5.Use hierarchical regression to analyze the influencing factors of serum Inhibin-A.[Results]1.Normal groupβ-hCG is(40.07±11.73)U/ml,AFP is(40.03±10.42)ng/ml,Inhibin-A is(332.39±86.59)pg/ml,which is significantly lower than that of Downsyndrome group(60.19±13.86)U/ml,AFP is(61.52±11.87)ng/ml,Inhibin-A is(705.46±193.85)pg/ml;and uE3 is(2.45±0.91)ng/ml,which is significantly higher than Down-The syndrome is(1.48±0.62)ng/ml,and the above differences are statistically significant(P<0.001).2.Pearson correlation analysis showed that serum Inhibin-A levels of pregnant women in the normal group were positively correlated with β-hCG and AFP(r=0.658,0.627,P<0.05),and negatively correlated with uE3(r=-0.617,P<0.05)The serum Inhibin-A level of pregnant women in the Down-syndrome group was positively correlated with β-hCG and AFP(r=0.519,0.671,P<0.05),and negatively correlated with uE3(r=-0.592,P<0.05),3.ROC curve analysis shows that the AUC of the dual screening,the triple screening and the combined screening Down-syndrome are 0.864(95%CI:0.779～0.949),0.942(95%CI;0.975～1.000),0.990(95%CI:895～0.990),respectively,the sensitivity and specificity of the dual screening are 83.3%,88.1%,and the triple screening is 93.3%,88.1%,quadruple of 96.7%,96.4%,the diagnostic value is high.4.When the median value of serum Inhibin-A in the normal group was 329.03 pg/ml,the MOM value was 1,and when the median value of serum Inhibin-A in the Down-syndrome group was 666.40 pg/ml,the MOM value was 2.03.And the double(AFP+β-hCG)screening method detects Down-syndrome with a positive detection rate of 70%(21/30)and false positive 8.33%(7/84);triple(AFP+β-hCG+uE3)screening Methods The positive detection rate of Down-syndrome was 76.67%(23/30),and the false positive rate was 5.95%(5/84);the quadruple(AFP+β-hCG+uE3+Inhibin-A)screening method was used to detect Down-comprehensive The positive detection rate of the sign was 83.33%(25/30),and the false positive rate was 3.57%(3/84).5.Hierarchical regression analysis showed that vaginal bleeding,maternal BMI,gestational diabetes,and fetal gender had no significant difference in the effects of Inhibin-A levels(P>0.05),while maternal BMI would affect Inhibin-A level(P<0.001).However,smoking had a significant negative effect on Inhibin-A levels influence relationship(P<0.001).[Conclusion]1.Inhibin-A is a relatively sensitive and effective screening indicator for Downsyndrome in the second trimester of pregnancy.It has a high predictive value for Down-syndrome in the second trimester,and is based on the existing serum detection markers in Down’s screening.Adding the Inhibin-A test can significantly increase the detection rate of Down’s screening.2.Serum Inhibin-A levels are correlated with serum β-hCG,uE3 and AFP in healthy pregnant women and pregnant women with Down-syndrome.3.Smoking can have negative influence on serum Inhibin-A level in pregnant women.