Lerthiranwong Thitikarn, Wanapirak Chanane, Sirichotiyakul Supatra, Tongprasert Fuanglada, Srisupundit Kasemsri, Luewan Suchaya, Tongsong Theera
a Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University , Chiang Mai , Thailand.
J Matern Fetal Neonatal Med. 2018 Nov;31(21):2847-2851. doi: 10.1080/14767058.2017.1358264. Epub 2017 Aug 2.
The objective of this study is to compare the effectiveness of first-trimester maternal serum screening (MSS) for fetal Down syndrome among Thai women between the method using Caucasian reference ranges with racial factor correction (CRR-RC) and that using Thai reference ranges (TRR).
A prospective database of MSS was accessed. The levels of PAPP-A and beta-hCG were calculated to determine their MoMs (multiple of medians) by two methods: (1) CRR-RC for Asian women and (2) TRR. The MoMs from both methods were used to determine the fetal risk.
Of 24,885 women including 36 fetuses with Down syndrome, the detection rates were significantly higher with TRR when compared with CRR-RC, 77.8 and 63.9%, respectively, p < .001. Additionally, the false-positive rates were significantly lower with TRR when compared to CRR-RC (7.5 versus 12.5%, respectively, p < .001) Conclusions: The effectiveness of MSS was much better by using our own reference ranges rather than the method of racial factor correction. The important insight is that ethnicity strongly impacts on the effectiveness that cannot be completely corrected by ethnic factor. MSS derived by the CRR-RC in other regions should be interpreted with high precaution, especially where the biophysical characteristics of the women are much different from Caucasian population.
本研究的目的是比较在泰国女性中，使用经种族因素校正的白种人参考范围（CRR-RC）的方法与使用泰国参考范围（TRR）的方法，在孕早期母体血清筛查（MSS）检测胎儿唐氏综合征方面的有效性。
访问了一个MSS的前瞻性数据库。通过两种方法计算妊娠相关血浆蛋白-A（PAPP-A）和β-人绒毛膜促性腺激素（β-hCG）的水平，以确定它们的中位数倍数（MoM）：（1）针对亚洲女性的CRR-RC；（2）TRR。两种方法得出的MoM均用于确定胎儿风险。
在24,885名女性中，有36例胎儿患有唐氏综合征，与CRR-RC相比，TRR的检出率显著更高，分别为77.8%和63.9%，p < 0.001。此外，与CRR-RC相比，TRR的假阳性率显著更低（分别为7.5%和12.5%，p < 0.001）。结论：使用我们自己的参考范围而非种族因素校正方法，MSS的有效性要好得多。重要的是，种族对有效性有强烈影响，无法通过种族因素完全校正。在其他地区，通过CRR-RC得出的MSS结果应高度谨慎解读，尤其是在女性的生物物理特征与白种人群有很大差异的地方。
