替代或添加胎盘生长因子对唐氏综合征筛查的影响：一项前瞻性队列研究。

Impact of replacing or adding placental growth factor on Down syndrome screening: A prospective cohort study.

机构信息

Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong.

出版信息

Prenat Diagn. 2021 Aug;41(9):1111-1117. doi: 10.1002/pd.5986. Epub 2021 Jun 24.

DOI:10.1002/pd.5986

PMID:34166535

Abstract

OBJECTIVES

To assess whether adding placental growth factor (PlGF) or replacing pregnancy-associated plasma protein-A (PAPP-A) improves the first trimester combined test performance for trisomy 21.

METHODS

A total of 11,518 women with a singleton pregnancy who underwent the first trimester combined test between December 2016 and December 2019 were included. PlGF was measured and estimated term risk for trisomy 21 was calculated by (1) adding PlGF to the combined test and (2) replacing PAPP-A with PlGF.

RESULTS

Twenty-nine pregnancies had trisomy 21. The combined tests detection rate (DR), false positive rate (FPR) and screen positive rate (SPR) were 89.7%, 5.7% and 6% respectively. DR when adding PlGF to the combined test or replacing PAPP-A remained unchanged. Replacing PAPP-A by PlGF increased FPR and SPR to 6.2% and 6.4% respectively. Adding PlGF to the combined test gave FPR and SPR rates of 5.5% and 5.7% respectively. Change in FPR and SPR was not significant (p > 0.1 for all).

CONCLUSION

Adding PlGF to the combined test or replacing PAPP-A with PlGF did not improve trisomy 21 DR and resulted in a non-significant marginal change in FPR and SPR.

摘要

目的

评估添加胎盘生长因子（PlGF）或用 PlGF 替代妊娠相关血浆蛋白-A（PAPP-A）是否能提高 21 三体综合征的早孕期联合筛查效能。

方法

本研究共纳入了 11518 例在 2016 年 12 月至 2019 年 12 月期间接受早孕期联合筛查的单胎妊娠孕妇。检测 PlGF 水平，并通过（1）将 PlGF 添加到联合筛查中，（2）用 PlGF 替代 PAPP-A，计算 21 三体综合征的估计风险。

结果

29 例孕妇怀有 21 三体综合征患儿。联合筛查的检出率（DR）、假阳性率（FPR）和筛查阳性率（SPR）分别为 89.7%、5.7%和 6%。添加 PlGF 到联合筛查或用 PlGF 替代 PAPP-A 后，DR 没有变化。用 PlGF 替代 PAPP-A 会使 FPR 和 SPR 分别增加到 6.2%和 6.4%。将 PlGF 添加到联合筛查中会使 FPR 和 SPR 分别达到 5.5%和 5.7%。FPR 和 SPR 的变化没有统计学意义（所有比较的 p 值均>0.1）。