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为探究母亲中孕期血清学三联筛查指标MoM值异常与先天性心脏病(congenital heart defects,CHD)相关性,采用以下研究方法:(1)收集2012-2013年宁波地区参加中孕期血清筛查,有完整随访资料,并结束妊娠的孕妇121 404例。(2)计算每1例样本甲胎蛋白(AFP)、游离β人绒毛膜促性腺激素(fβ-hCG)和游离雌三醇(uE3)的MoM值和风险值。对妊娠结局为CHD与正常妊娠结局孕妇血清学筛查指标的MoM值进行比较。(3)组间率比较采用χ2、Fisher′s精确概率检验。结果显示:(1)121 404例妊娠中,正常妊娠结局119 845例(正常结局组);发现除目标疾病21三体、18三体、开放性神经管缺陷(ONTD)外,胎儿结构异常1 174例,其中CHD 578例(CHD组);其他不良妊娠结局314例。(2)两组孕妇三联指标MoM值比较,差异有统计学意义(P<0.05)。(3)比较两组AFP、fβ-hCG MoM值升高、uE3 MoM值降低,以及MoM值三项异常的发生率,差异有统计学意义。AFP、fβ-hCG的MoM值降低及三联指标MoM值单项、两项异常在两组妊娠结局中差异无统计学意义。(4)两组孕妇AFP、fβ-hCG MoM值异常升高、uE3 MoM值异常降低及三项指标MoM值均异常,CHD发生风险增加。孕中期产前筛查高风险,以及血清指标MoM值异常人群中,除筛查目标疾病外,CHD的发生相对也高。对筛查指标异常人群应提供更加客观、全面的咨询,并重视对胎儿CHD的诊断和孕期监护。
To explore the relationship between the abnormal serum MoM in pregnancy and congenital heart defects (CHD) in pregnant women, the following research methods were used: (1) To collect the serum screening of pregnant women in Ningbo in 2012-2013 , 121,404 pregnant women with complete follow-up data and ending pregnancy. (2) Calculate the MoM value and risk value of AFP, free beta human chorionic gonadotropin (fβ-hCG) and free estriol (uE3) in each case. The outcome of pregnancy was compared with the MoM of serological markers of CHD in pregnant women with normal pregnancy outcome. (3) Comparison between groups using χ2, Fisher’s exact test. The results showed that: (1) Among 121,404 pregnancies, there were 119,845 normal pregnancies (normal outcome group). Except 21T3, 18T3, open neural tube defects (ONTD) 174 cases, including CHD 578 cases (CHD group); other adverse pregnancy outcomes in 314 cases. (2) There was significant difference in MoM between the three groups (P <0.05). (3) The two groups of AFP, fβ-hCG MoM value, uE3 MoM value decreased, and MoM value of the three abnormalities, the difference was statistically significant. AFP, fβ-hCG decreased MoM value and triple index MoM value of a single, two abnormalities in the two groups of pregnancy outcomes no significant difference. (4) The AFP and fβ-hCG MoM values were abnormally elevated in both groups, the abnormal decrease of uE3 MoM value and the three index MoM values were abnormal, and the risk of CHD increased. The high risk of prenatal screening in the second trimester, and the abnormal serum MoM values, the incidence of CHD is relatively high except for screening for the target disease. Abnormal screening indicators should provide more objective and comprehensive counseling, and attach importance to the diagnosis of fetal CHD and pregnancy monitoring.