Hui Dini, Okun Nan, Murphy Kellie, Kingdom John, Uleryk Elizabeth, Shah Prakesh S
Maternal Fetal Medicine Division, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto ON.
Maternal Fetal Medicine Division, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto ON.
J Obstet Gynaecol Can. 2012 Feb;34(2):142-153. doi: 10.1016/S1701-2163(16)35157-X.
Abnormal serum screening markers have been associated with adverse pregnancy outcomes. We sought to review the performance of combined abnormal first and/or second trimester maternal serum markers used in prenatal screening for aneuploidy and open neural tube defects for predicting preeclampsia (PET), small for gestational age (SGA), and stillbirth beyond 24 weeks' gestation.
Medline, EMBASE, and Cochrane Library databases were searched for studies from 1970 to May 2010 that analyzed predictive abilities of combined serum markers for defined outcomes.
Data were extracted independently by two authors, and 15 studies were included. Eight studies of 115,290 pregnancies, 11 studies of 144 853 pregnancies, and seven studies of 80 274 pregnancies examined PET, SGA, and stillbirth respectively. Because of the heterogeneity of marker combinations and thresholds, outcome definitions, and analytic methods, limited meta-analysis was possible for the outcomes of PET and SGA only. Three relatively homogeneous studies on prediction of PET, and two on prediction of SGA were meta-analyzed. Several single studies demonstrated utility in combining markers to predict adverse outcome; however, this effect was not confirmed after meta-analysis. The most common combination of markers evaluated was alpha fetoprotein and human chorionic gonadotrophin for all outcomes. The highest positive likelihood ratios for predicting PET (5.68; 95% CI 0.73 to 43.97) and SGA (6.18; 95% CI 1.84 to 20.85) were seen with combined alpha fetoprotein and human chorionic gonadotrophin (> 2.5 multiples of the median).
Currently, no identifiable combination of serum markers performs well as a screening test for preeclampsia, small for gestational age, and stillbirth beyond 24 weeks. Large cohort studies with standardized screening test parameters and outcomes are needed.
异常血清筛查标志物与不良妊娠结局相关。我们旨在回顾孕早期和/或孕中期联合使用的异常母体血清标志物在产前筛查非整倍体和开放性神经管缺陷中预测子痫前期（PET）、小于胎龄儿（SGA）以及妊娠24周后死产的效能。
检索了Medline、EMBASE和Cochrane图书馆数据库，查找1970年至2010年5月期间分析联合血清标志物对特定结局预测能力的研究。
由两位作者独立提取数据，纳入了15项研究。分别有8项研究（涉及115290例妊娠）、11项研究（涉及144853例妊娠）以及7项研究（涉及80274例妊娠）对PET、SGA和死产进行了研究。由于标志物组合及阈值、结局定义和分析方法的异质性，仅对PET和SGA结局进行了有限的荟萃分析。对三项关于PET预测的相对同质的研究以及两项关于SGA预测的研究进行了荟萃分析。多项单项研究表明联合标志物预测不良结局具有一定作用；然而，荟萃分析后这一效应未得到证实。评估的最常见标志物组合在所有结局中均为甲胎蛋白和人绒毛膜促性腺激素。甲胎蛋白和人绒毛膜促性腺激素联合（>中位数的2.5倍）时，预测PET（5.68；95%CI 0.73至43.97）和SGA（6.18；95%CI 1.84至20.85）的阳性似然比最高。
目前，尚无可识别的血清标志物组合能作为子痫前期、小于胎龄儿以及妊娠24周后死产的良好筛查试验。需要开展具有标准化筛查试验参数和结局的大型队列研究。
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