新生儿早期的甲胎蛋白——一项大型研究及文献综述

Alpha-fetoprotein in the early neonatal period--a large study and review of the literature.

作者信息

Bader D, Riskin A, Vafsi O, Tamir A, Peskin B, Israel N, Merksamer R, Dar H, David M

机构信息

Department of Neonatology, Bnai Zion Medical Center, The B. Rappaport Faculty of Medicine, Technion. Israel Institute of Technology, 47 Golomb Street, P.O.B. 4940, Haifa, Israel.

出版信息

Clin Chim Acta. 2004 Nov;349(1-2):15-23. doi: 10.1016/j.cccn.2004.06.020.

DOI:10.1016/j.cccn.2004.06.020

PMID:15469851

Abstract

BACKGROUND

Alpha-fetoprotein (AFP) is a glycoprotein molecule, which has similarity to albumin and is produced by the fetal liver. Its biological role is unclear and factors that may influence its concentrations in neonates are only partially identified. However, it has an important role as a diagnostic marker, especially in certain tumors and liver diseases of childhood. Its normal reference values in newborns have not been well defined.

METHODS

Serum AFP concentrations were measured and characterized in 260 term and near-term newborns [gestational age (GA)> or =34 weeks, birthweight (BW)> or =1700 g] at birth [umbilical cord (UC) blood] and upon discharge from the nursery at 60+/-24 h of life (venous sample).

RESULTS

Due to the nonnormal distribution of AFP levels, it is useful to relate to reference interval for AFP concentrations at birth that was 15.7-146.5 microg/ml, based on 95% confidence interval (CI). The median value of 48.3 microg/ml is also a useful reference. However, mean AFP concentrations at birth that were 61.6+/-44.8 microg/ml are less informative due to the large standard deviation (S.D.). Upon discharge, AFP concentrations dropped to 9.7-111.9 microg/ml (95% CI) with a median of 34.2 microg/ml. A significant negative correlation was found between AFP serum levels and gestational age and to a lesser extent with birthweight. No significant differences were found between males and females.

CONCLUSIONS

Normal reference intervals for AFP in term and near-term newborns have been defined, but need to be addressed with caution due to the wide range of normal values. AFP levels at birth decrease as gestation advances and the newborn weighs more.

摘要

背景

甲胎蛋白（AFP）是一种糖蛋白分子，与白蛋白相似，由胎儿肝脏产生。其生物学作用尚不清楚，仅部分确定了可能影响新生儿体内其浓度的因素。然而，它作为一种诊断标志物具有重要作用，尤其是在儿童期的某些肿瘤和肝脏疾病中。其在新生儿中的正常参考值尚未明确界定。

方法

对260名足月儿和近足月儿[胎龄（GA）≥34周，出生体重（BW）≥1700 g]出生时（脐带血）及出生后60±24小时从育婴室出院时（静脉血样）的血清AFP浓度进行了测定和特征分析。

结果

由于AFP水平呈非正态分布，基于95%置信区间（CI），出生时AFP浓度的参考区间为15.7 - 146.5 μg/ml，这一区间很有用。中位数48.3 μg/ml也是一个有用的参考值。然而，由于标准差（S.D.）较大，出生时AFP平均浓度61.6±44.8 μg/ml的信息量较少。出院时，AFP浓度降至9.7 - 111.9 μg/ml（95% CI），中位数为34.2 μg/ml。发现AFP血清水平与胎龄之间存在显著负相关，与出生体重的负相关程度较小。男性和女性之间未发现显著差异。