| Object:To investigate the clinical significance of AFP,uE3,Freeβ-hCG in prenatal screen and the influence factors of risk assessments.Method:The value of AFP, UE3, Freeβ-HCG in serum of the pregnant women at 14-20 weeks were tested by automated chemiluminescence Immunoassay System, the risk assessment was made using analytical software provided from Beckman Corporation in America. Rate>1:380 was viewed as high risk in Downs'Syndrome;>1:334 in Trisomy 18;>1:1000 in OSB. Advised women who in high risk to have amniocentest or ultrasonography. Observed the process and outcome of 2090 pregnant women from 2005.7 to 2009.9.Results:1. There were 16 at high risk (>1:380) in DS,7 of them accepted amniocentesis,2 was finally diagnosed by analysis of chromosome in the cell of anmlotlc fluid, the other 9 refused invasive procedures and were diagnosed negative after childbirth. Those in high risk were mostly over 35 years old and with age, screening positive rate increased.The screening positive rate in the group of over 35 years old and the others were 4.43% and 0.37%, the differences in screening positive rate between two groups was significant, while in confirmed positive rate was not. The differences in morbility between the group of high risk and low risk was significant(p<0.005).2. There were 12 at high risk (>1:334) in Trisomy18,2 was finally diagnosed by analysis of chromosome in the cell of anmlotlc fluid. Those in high risk were mostly over 35 years old and with age, screening positive rate increased. The screening positive rate in the group of over 35 years old and the others were 1.97% and 0.42%, the differences in screening positive rate between two groups was significant(p<0.01) and in confirmed positive rate was also.The differences in morbility between the group of high risk and low risk was significant(p<0.005).3. There were 14 at high risk in OSB,2 was finally diagnosed. The differences in screening positive rate between the group of age in 20-24 and in 25-29 was not significant(p>0.1), between the group of age in 30-34 and in 25-29 was not significant (p>0.1). The differences in screening positive rate between the group of over 35 years old and the others was significant(p<0.01) and in confirmed positive rate was also. The differences in morbility between the group of high risk and low risk was significant(p<0.005).4. High detection rate of prenatal screen with AFP,uE3,Freeβ-hCG were 100%, false positive rate were 0.67%%,0.48%,0.57% and false negative rate were 0%.5. There were 10 birth defect in high risk, the rate of birth defect was 23.81%. The rate of birth defect in our city at the same time was 448/25239=1.78%, the differences between them was significant. 6. There were 5754 pregnant women in our hospital from 2005.7 to 2009.9. 2 DS and 3 OSB were missed because of not attending normal prenatal screen. (2 of them diagnosed by ultrasonography)The rate of missed diagnosis of 2090 pregnant women with screen was 0%. The rate of missed diagnosis of 3664 pregnant women without screen was 71.43%(5/7), the differences between them was significant. Detectable rate of pregnant women with screen was 100%, Detectable rate of pregnant women without screen but ultrasonography was 28.57%(2/7), the differences between them was significant. Conclusion:1. The analysis of AFP, uE3 andβ-HCG in serum to diagnosis Downs' syndrome,Trisomy18, OSB was ideal because it had high detection rate, low false positive rate and false negative rate while was convenient and low-cost. To reduce the false positive determination should continue to improve or close follow-up to observe.2. Age was important influencing factor to the risk assessment.3. Prenatal screen with AFP,UE3,Freeβ-hCG was also effective in other birth defect.4. Low fraction of coverage in prenatal screen was important reason of miss diagnosis.5. Ultrasonography was important in prenatal screen in the base of the analysis of AFP, UE3 and B-HCG in serum.
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