孕中期甲胎蛋白和游离β人绒毛促性腺激素及脐动脉血流变化与不良妊娠结局的关系_临床医学论文.docVIP

孕中期甲胎蛋白和游离β人绒毛促性腺激素及脐动脉血流变化与不良妊娠结局的关系_临床医学论文 孕中期甲胎蛋白和游离β人绒毛促性腺激素及脐动脉血流变化与不良妊娠结局的关系_临床医学论文 作者：侯红瑛， 王林琳， 吴玲玲， 张新玲， 黄冬梅 【摘要】 【目的】 探讨孕中期母血清标志物及脐动脉血流用于预测不良妊娠结局的临床价值。【方法】 采用时间分辨荧光分析技术，对876例孕14 ～ 21周的孕妇进行孕中期甲胎蛋白(AFP)、游离β人绒毛促性腺激素(free-β-hCG)检测;对其中536例孕妇在孕14 ～ 28周使用超声多普勒检测其脐动脉血流，并追踪其妊娠结局。用卡方检验比较孕妇血清标志物升高者(342例)、脐动脉血流异常者(82例)、血清标志物升高且脐动脉异常者(40例)之间不良妊娠结局的发生率的差别。【结果】 与母血清标志物升高有关的不良结局有子痫前期、新生儿窒息、胎儿生长受限、胎儿丢失及胎盘异常。这些相关的不良妊娠结局的发生率在血清标志物升高组为12.65%，在脐动脉血流异常组为8.5%，在血清学标志物与脐动脉血流两者同时异常组为30.95%，与前两组相比有统计学差异。【结论】 孕中期母血清标志物升高合并脐动脉血流异常者，发生不良妊娠结局的风险升高。 【关键词】 孕中期; 甲胎蛋白; 游离β人绒毛膜促性腺激素; 脐动脉血流; 多普勒; 不良妊娠结局 　Abstract： 【Objective】 To investigate the clinical value of second trimester maternal serum screening and umbilical artery Doppler for prediction of adverse pregnancy outcome. 【Method】 A total of 876 women were taken blood sample during 14 to 21 weeks for the measurement of alpha fetoprotein and free β human chorionic gonadotropin with time-resolved fluorescence assay. Among them， 536 cases were measured the umbilical artery index with color ultrasound Doppler during 14 to 28 weeks. In the end， the pregnancy outcome was record and analyzed. We compared the difference of incidence of adverse outcome between the group of high levels of maternal serum markers (342 cases)， the group of abnormal umbilical artery index (82 cases)， and the group of both maternal serum markers and umbilical artery index were abnormal (40 cases). 【Result】 The high levels of maternal serum markers was significantly associated with preeclampsia， neonatal asphyxia， fetal growth restriction， fetal demise， and abnormal placenta. The incidence of associated adverse outcome was 12.65% in the group of high levels of maternal serum markers， 8.5% in the group of abnormal umbilical artery index， and 30.95% in the group that both maternal serum markers and umbilical artery index were abnormal. The adverse outcome incidence of the last group was significant higher than the former two. 【Conclusion】 High levels of maternal serum mark