孕中期羊水AFP水平与不良妊娠结局分析

Analysis of the Relationship between the Level of Second Trimester Amniotic Fluid Alpha-Fetoprotein and Adverse Pregnancy Outcomes

摘要: 目的：了解孕中期羊水AFP水平及其与不良妊娠的关系。方法：对孕中期妊娠25,038例羊水采用酶联免疫吸附法进行AFP检测，随访妊娠结局，建立羊水AFP参考值及2.5 MoM。结果：孕16~23 w羊水参考值上限为15,665.6~28,766.9 ng/ml，2.5 MoM为18,712.3~38,694.3 ng/ml，且其值随孕周增加而降低，开放神经管缺陷、颈部淋巴管瘤、死胎和腹部畸形妊娠羊水AFP异常比例较高，其他不良妊娠结局则较低，但其AFP值明显增加。结论：羊水AFP异常升高与神经管缺陷、颈部淋巴管瘤、死胎和腹部畸形等不良妊娠相关，但仍有一定漏诊和误诊，应结合动态超声监测以确诊和排除相关畸形。

Abstract: Objective: To investigate the level of second trimester amniotic fluid alpha-fetoprotein (AFP) and the relationship between the level of AFP and adverse pregnancy outcomes. Methods: The concen-tration of AFP in amniotic fluid sample from 25,038 second trimester pregnancy women was de-tected by using enzyme linked immunosorbent assay. The outcomes were recorded. Results: The upper limit of reference range and 2.5 MoM of the AFP in different gestational weeks are from 15,665.6 to 28,766.9 ng/ml and from 18,712.3 to 38,694.3 ng/ml, and the level of AFP was high with increasing gestational age. The proportion of abnormal AFP were higher in Neural tube defects (NTDs), cystic hygroma, fetal demise and ventral wall defects (VWDs), and that were low in others, but all of them had abnormal increased AFP value significantly. Conclusion: Levels of AFP correlate with the likelihood of NTDs, cystic hygroma, fetal demise and VWDs. But some pregnancies were misdiagnosed or missed. In order to identify and eliminate related deformities, ultrasound should be needed for further diagnosis.