Lenke R R, Guerrieri J, Nemes J M, Kurczynski T W, French B, Gray M, Schut H, Ashwood E R
Department of Obstetrics and Gynecology, Medical College of Ohio, Toledo.
J Reprod Med. 1989 Aug;34(8):511-6.
Most maternal serum alpha-fetoprotein (MSAFP) screening programs are set up with the goal of prenatal detection of fetal neural tube defects. It is also commonly accepted that MSAFP testing yields many false-positive results. Screening programs commonly utilize schemata that identify abnormal levels of MSAFP as greater than 2.5 multiples of the median (MOM) and also recommend two abnormal values before initiating ultrasound evaluation. Our pilot program evaluating obstetric outcomes found that 21 of the 29 women with elevated MSAFP values (greater than 2.0 MOM) eventually developed significant pregnancy management changes or complications of pregnancy. Thus, we believe that the use of MSAFP screening solely for the purpose of detecting fetal neural tube defects is inconsequential relative to its usefulness in detecting other pregnancy abnormalities. We also believe that ultrasound evaluation should be accomplished after the first abnormal value and that the cutoff of 2.5 MOM should be lowered to at least 2.0.
大多数母血清甲胎蛋白（MSAFP）筛查项目的设立目标是产前检测胎儿神经管缺陷。人们也普遍认为，MSAFP检测会产生许多假阳性结果。筛查项目通常采用一些方案，将MSAFP异常水平确定为大于中位数的2.5倍（MOM），并且还建议在开始超声评估之前要有两个异常值。我们评估产科结局的试点项目发现，29名MSAFP值升高（大于2.0MOM）的女性中，有21名最终出现了重大的妊娠管理变化或妊娠并发症。因此，我们认为，仅为检测胎儿神经管缺陷而使用MSAFP筛查，相对于其在检测其他妊娠异常方面的作用而言是无关紧要的。我们还认为，超声评估应在首次出现异常值后进行，并且2.5MOM的临界值应至少降至2.0。
