Van den Veyver I B, Moise K J
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
Obstet Gynecol. 1996 Dec;88(6):1061-7. doi: 10.1016/s0029-7844(96)00348-1.
To review the specificity and sensitivity of diagnostic techniques using the polymerase chain reaction (PCR) on amniotic fluid (AF) samples for the determination of fetal RhD status.
A MEDLINE computerized search was conducted for January 1991 through March 1996 using the key terms "polymerase chain reaction," "rhesus," and "RhD typing."
All articles describing the use of PCR in AF for RhD typing were reviewed. Only cases in which the results of PCR testing were confirmed by fetal or neonatal serology were included in the final analysis.
TABULATION, INTEGRATION, AND RESULTS: The results of PCR typing were compared with serology to determine the sensitivity, specificity, and positive and negative predictive values of DNA-based techniques. A total of 500 cases were reviewed, in which four different sets of oligonucleotide primers were used. The sensitivity and specificity of PCR typing were 98.7% and 100%, respectively, and the positive and negative predictive values were 100% and 96.9%, respectively. In five cases, an RhD-positive fetus was incorrectly diagnosed: Two fetuses died, one neonate needed exchange transfusions, and another neonate needed phototherapy in conjunction with a simple transfusion. The remaining infant was lost to follow-up. A theoretical model indicated that amniocentesis with PCR-based techniques for fetal RhD typing would be associated with a fourfold reduction in perinatal loss compared with funipuncture and serology for fetal typing.
This lower rate of procedure-related loss makes RhD typing using AF the preferred method for assessing the fetal Rh status in cases of a heterozygous paternal genotype.
回顾利用聚合酶链反应（PCR）检测羊水（AF）样本以确定胎儿RhD血型状态的诊断技术的特异性和敏感性。
利用关键词“聚合酶链反应”“恒河猴”和“RhD分型”对1991年1月至1996年3月期间的MEDLINE数据库进行计算机检索。
对所有描述利用PCR技术检测羊水中RhD分型的文章进行综述。最终分析仅纳入PCR检测结果经胎儿或新生儿血清学证实的病例。
列表、整合与结果：将PCR分型结果与血清学结果进行比较，以确定基于DNA技术的敏感性、特异性、阳性预测值和阴性预测值。共回顾了500例病例，使用了四组不同的寡核苷酸引物。PCR分型的敏感性和特异性分别为98.7%和100%，阳性预测值和阴性预测值分别为100%和96.9%。有5例RhD阳性胎儿被误诊：2例胎儿死亡，1例新生儿需要换血治疗，另1例新生儿需要光疗并辅以简单输血。其余婴儿失访。一个理论模型表明，与采用脐血穿刺和血清学进行胎儿分型相比，采用基于PCR技术的羊水穿刺进行胎儿RhD分型可使围产期损失降低四倍。
这种与操作相关的较低损失率使得在父本基因型为杂合子的情况下，利用羊水进行RhD分型成为评估胎儿Rh状态的首选方法。
