Roberts C J, Hibbard B M, Elder G H, Evans K T, Laurence K M, Roberts A, Woodhead J S, Robertson I B, Hoole M
Lancet. 1983 Jun 11;1(8337):1315-8. doi: 10.1016/s0140-6736(83)92424-8.
Serum-alpha-fetoprotein (AFP) levels were measured in more than 15 000 pregnant women in an investigation designed to examine the operational issues entailed in a large-scale population screening programme for antenatal detection of neural-tube defects. The proportion of open neural-tube defects (ONTD) terminated as a result of serum screening was 56.1% (66.6% for anencephaly and 40.7% for open spina bifida). The principle causes of poor efficacy were: failure of pregnant women to undergo screening (18.2% of ONTD were not screened); failure of the screening test to detect ONTD (20.4% of those screened were below the 90th centile); decisions against termination of detected ONTD (14% of ONTD detected by serum AFP were not terminated). Given present practices and knowledge it is doubtful whether overall efficacy levels above 65% for open spina bifida can be achieved under normal service conditions. The establishment of a regional or national screening programme on grounds of clinical efficacy alone may be premature. The decision would seem to hinge principally around a careful consideration of the economic issues.
在一项旨在检查大规模人群筛查计划中有关产前检测神经管缺陷的操作问题的调查中，对超过15000名孕妇进行了血清甲胎蛋白（AFP）水平检测。因血清筛查而终止妊娠的开放性神经管缺陷（ONTD）比例为56.1%（无脑儿为66.6%，开放性脊柱裂为40.7%）。疗效不佳的主要原因是：孕妇未接受筛查（18.2%的ONTD未接受筛查）；筛查试验未能检测出ONTD（20.4%接受筛查的孕妇低于第90百分位数）；决定不终止检测出的ONTD（血清AFP检测出的ONTD中有14%未被终止妊娠）。鉴于目前的做法和知识水平，在正常服务条件下，开放性脊柱裂的总体疗效水平能否超过65%令人怀疑。仅基于临床疗效建立区域或国家筛查计划可能为时过早。这一决定似乎主要取决于对经济问题的仔细考虑。
