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扩展携带者筛查:当前视角

Expanded carrier screening: A current perspective.

作者信息

Mastantuoni Enrica, Saccone Gabriele, Al-Kouatly Huda B, Paternoster Mariano, D'Alessandro Pietro, Arduino Bruno, Carbone Luigi, Esposito Giuseppina, Raffone Antonio, De Vivo Valentino, Maruotti Giuseppe Maria, Berghella Vincenzo, Zullo Fulvio

机构信息

Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.

Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2018 Nov;230:41-54. doi: 10.1016/j.ejogrb.2018.09.014. Epub 2018 Sep 13.

Abstract

Prenatal carrier screening has expanded to include a large number of genes offered to all couples considering pregnancy or with an ongoing pregnancy. Expanded carrier screening refers to identification of carriers of single-gene disorders outside of traditional screening guidelines. Expanded carrier screening panels include numerous autosomal recessive and X-linked genetic conditions, including those with a very low carrier frequency, as well as those with mild or incompletely penetrant phenotype. Therefore, the clinical utility of these panels is still subject of debate. Priority should be given to carrier screening panels that include a comprehensive set of severe childhood-onset disorders. Psychosocial support and genetic couseling should be available prior to screening and for the return of positive results. Systems are needed to reduce the risk of misinterpreting results. Finally, attention should be paid on the impact of expanded carrier screening on health care organizations and burden of cost.

摘要

产前携带者筛查已扩大到包括向所有考虑怀孕或正在怀孕的夫妇提供大量基因检测。扩大的携带者筛查是指在传统筛查指南之外识别单基因疾病的携带者。扩大的携带者筛查 panel 包括许多常染色体隐性和 X 连锁遗传疾病,包括那些携带者频率非常低的疾病,以及那些具有轻度或不完全显性表型的疾病。因此,这些 panel 的临床效用仍存在争议。应优先考虑包括一系列严重儿童期发病疾病的携带者筛查 panel。在筛查前以及阳性结果反馈时应提供心理社会支持和遗传咨询。需要建立系统以降低结果误判的风险。最后,应关注扩大的携带者筛查对医疗保健机构的影响和成本负担。

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