体外受精（新鲜和冻融）妊娠中早孕期 PAPP-A 水平低，可能与生物学因素有关。
Low first-trimester PAPP-A in IVF (fresh and frozen-thawed) pregnancies, likely due to a biological cause.
机构信息
Genetic Health Queensland, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia.
School of Natural Sciences, Griffith University, 170 Kessels Road, Nathan, QLD, 4111, Australia.
出版信息
J Assist Reprod Genet. 2017 Oct;34(10):1367-1375. doi: 10.1007/s10815-017-0996-1. Epub 2017 Jul 17.
PURPOSE
The purpose of this study is to confirm a difference in the first-trimester screen maternal biochemistry and false-positive rates (FPR) between pregnancies conceived spontaneously and those conceived via assisted reproductive technologies (ART).
METHODS
Retrospective analysis of the complete population of women (17,889 pregnancies) who had undergone first-trimester screening between January 2004 and September 2009 at three private ultrasound clinics in Queensland, Australia was used in the study. The age, gestation, method of conception, ultrasound markers, biochemistry markers (PAPP-A, fβ-hCG), and type of biochemical analyzer platform (Brahms Kryptor, Immulite 2000) data was collated. Univariate analysis of variance (ANOVA), Spearman's rank nonparametric correlation analysis, and Binary Logistic Regression analysis were used to analyze data. Spontaneous pregnancies were used as controls. Results were considered significant when the p value was less than 0.05.
RESULTS
After exclusions, 16,363 singleton pregnancies, including 1543 conceived via ART, were analyzed. Results from the two biochemistry platforms, Brahms Kryptor and Immulite 2000 were significantly different (p < 0.001); thus, the data was divided for analysis purposes. PAPP-A was universally significantly lower in IVF pregnancies compared to spontaneously conceived pregnancies (p < 0.001). Using the Brahms Kryptor platform, ICSI was associated with significantly decreased PAPP-A (p < 0.046), and a significantly increased FPR (p = 0.012).
CONCLUSIONS
Consistent with previous studies IVF pregnancies had significantly lower PAPP-A levels supporting the need to appropriately adjust the combined first-trimester screening (cFTS) risk algorithm for IVF conceptions. The Brahms Kryptor and Immulite 2000 platforms are significantly different; however, the universally lower PAPP-A findings support the hypothesis that the lower PAPP-A is due to a biological cause.
目的
本研究旨在确认自然妊娠和辅助生殖技术（ART）妊娠的早孕期筛查母体生化指标和假阳性率（FPR）是否存在差异。
方法
本研究采用回顾性分析方法，对 2004 年 1 月至 2009 年 9 月期间在澳大利亚昆士兰州的三家私立超声诊所接受早孕期筛查的 17889 例妊娠的完整人群进行分析。收集了年龄、孕周、受孕方式、超声标志物、生化标志物（PAPP-A、fβ-hCG）以及生化分析仪平台（Brahms Kryptor、Immulite 2000）类型的数据。采用单因素方差分析（ANOVA）、Spearman 秩非参数相关分析和二项逻辑回归分析进行数据分析。以自然妊娠为对照。当 p 值小于 0.05 时，结果被认为具有统计学意义。
结果
排除后，分析了 16363 例单胎妊娠，其中 1543 例为 ART 受孕。两种生化分析仪平台（Brahms Kryptor 和 Immulite 2000）的结果差异有统计学意义（p<0.001）；因此，为分析目的将数据进行了分组。与自然受孕妊娠相比，IVF 妊娠的 PAPP-A 普遍显著降低（p<0.001）。使用 Brahms Kryptor 平台，ICSI 与 PAPP-A 显著降低（p<0.046）和 FPR 显著增加（p=0.012）相关。
结论
与以往研究一致，IVF 妊娠的 PAPP-A 水平显著降低，支持对 IVF 妊娠适当调整联合早孕期筛查（cFTS）风险算法的需求。Brahms Kryptor 和 Immulite 2000 平台差异显著；然而，普遍较低的 PAPP-A 发现支持这样一种假设，即较低的 PAPP-A 是由于生物学原因引起的。
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