Phillips O P, Simpson J L, Morgan C D, Andersen R N, Shulman L P, Meyers C M, Sibai B, Shaver D C, Tolley E A, Elias S
Department of Obstetrics and Gynecology, University of Tennessee, Memphis 38163.
Am J Obstet Gynecol. 1992 Mar;166(3):978-82. doi: 10.1016/0002-9378(92)91376-l.
The null hypothesis of this study is that in an urban, indigent obstetric population at high risk for adverse perinatal outcome, unexplained elevations of maternal serum alpha-fetoprotein are not an additional predictor of adverse perinatal outcome.
Perinatal outcomes of 72 patients from a clinic for indigent patients with unexplained elevated maternal serum alpha-fetoprotein levels were compared with those of matched controls from the same population with normal maternal serum alpha-fetoprotein levels. Subjects and controls were matched for age, race, parity, and presence or absence of Hollister risk factors. The frequency of adverse perinatal outcome in the two groups was subjected to matched-pair chi 2 analysis.
Adverse perinatal outcome occurred in 38.9% (28 of 72) of subjects with unexplained elevated maternal serum alpha-fetoprotein levels greater than or equal to 2.5 multiples of the median, compared with 31.9% (23 of 72) of controls with normal maternal serum alpha-fetoprotein levels (p = 0.5). No statistically significant difference in adverse perinatal outcomes was found.
Elevated maternal serum alpha-fetoprotein levels offer little if any additional predictive value for adverse perinatal outcome in populations already at high risk for such outcomes on the basis of obstetric or socioeconomic criteria.
本研究的无效假设是，在城市贫困产科人群中，围产期不良结局风险较高，孕妇血清甲胎蛋白水平不明原因升高并非围产期不良结局的额外预测因素。
将一家诊所中72例孕妇血清甲胎蛋白水平不明原因升高的贫困患者的围产期结局，与同一人群中血清甲胎蛋白水平正常的匹配对照组进行比较。受试者和对照组在年龄、种族、产次以及是否存在霍利斯特风险因素方面进行匹配。对两组围产期不良结局的发生率进行配对卡方分析。
孕妇血清甲胎蛋白水平不明原因升高且大于或等于中位数2.5倍的受试者中，38.9%（72例中的28例）出现围产期不良结局，而血清甲胎蛋白水平正常的对照组中这一比例为31.9%（72例中的23例）（p = 0.5）。未发现围产期不良结局存在统计学上的显著差异。
对于基于产科或社会经济标准已处于此类结局高风险的人群，孕妇血清甲胎蛋白水平升高即便有额外预测价值也微乎其微。
