Ultrasound Obstet Gynecol:小于胎龄儿的预测

2015-05-21 MedSci MedSci原创

目前对于小于胎龄儿(SGA)的产前预测依旧是难点。近期Lesmes C等人进行了一项研究探究孕妇19-24周孕时血清中胎盘生长因子(PlGF)、可溶性血管内皮生长因子受体-1(sFlt-1)、妊娠相关血浆蛋白-A (PAPP-A)、β-绒毛膜促性腺激素(β-hCG)以及甲胎蛋白(AFP)浓度,再结合孕妇本身因素和B超下胎儿的生物学指标对小于胎龄儿(SGA)的预测价值。该研究纳入了9715名单胎妊娠

目前对于小于胎龄儿(SGA)的产前预测依旧是难点。近期Lesmes C等人进行了一项研究探究孕妇19-24周孕时血清中胎盘生长因子(PlGF)、可溶性血管内皮生长因子受体-1(sFlt-1)、妊娠相关血浆蛋白-A (PAPP-A)、β-绒毛膜促性腺激素(β-hCG)以及甲胎蛋白(AFP)浓度,再结合孕妇本身因素和B超下胎儿的生物学指标对小于胎龄儿(SGA)的预测价值。

该研究纳入了9715名单胎妊娠孕妇,其中481 (5.0%)的孕妇没有子痫前期,分娩了小于胎龄儿(SGA)。对19-24周孕妇的母体因素、胎儿因素如头围、腹围、股骨长等,结合PLGF, sFlt-1, PAPP-A, ß-hCG 和AFP浓度等预测SGA的指标进行多因素logistic回归分析,判断该类指标对SGA的预测情况。并且研究者根据19-24周的筛查情况选择在32或36周进行孕晚期的评估。

研究结果显示,在37周前分娩的SGA <5th组,相比正常组,PlGF浓度更低,AFP浓度更高,而sFlt-1, PAPP-A 和β-hCG等指标两组间无统计学差异。结合母体因素、胎儿生物学指标、孕妇19-24周孕血清PlGF和AFP浓度对SGA <5th的预测情况分别为:32周前分娩 100%、32-36周分娩 76%、足月产(≥37周) 38%,预测假阳性率为(FPR)是10%。在这个研究者假设的模型中,如果要求产前筛查出80%的SGA <5th患者,那就需要在19-24周孕评估的孕妇中选择11%在32周孕进行再评估、46%的在36周孕进行再评估以及54%的并不需要进行孕晚期检测的孕妇。

研究结果表明,目前如果想在产前筛查出大部分的小于胎龄儿(SGA)从而进行针对性的护理和决策,那么需要结合孕中期筛查评估情况和孕晚期的B超检查,并且对于孕晚期的检查需要立足于19-24周孕的筛查结果,可能是32周也可能是36周。

原始出处:

Lesmes C, Gallo DM, Gonzalez R, Poon LC, Nicolaides KH. Prediction of small for gestational age neonates: Screening by maternal serum biochemical markers at 19-24 weeks. Ultrasound Obstet Gynecol. 2015 .

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    2016-01-29 yhy100200
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    2015-07-04 siiner
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[GetPortalCommentsPageByObjectIdResponse(id=2011191, encodeId=7371201119160, content=<a href='/topic/show?id=840d1e300e5' target=_blank style='color:#2F92EE;'>#TET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17300, encryptionId=840d1e300e5, topicName=TET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cc52251, createdName=yhy100200, createdTime=Fri Jan 29 12:46:00 CST 2016, time=2016-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1796555, encodeId=faad1e96555f6, content=<a href='/topic/show?id=57211812121' target=_blank style='color:#2F92EE;'>#Ultra#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18121, encryptionId=57211812121, topicName=Ultra)], attachment=null, authenticateStatus=null, 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  5. [GetPortalCommentsPageByObjectIdResponse(id=2011191, encodeId=7371201119160, content=<a href='/topic/show?id=840d1e300e5' target=_blank style='color:#2F92EE;'>#TET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17300, encryptionId=840d1e300e5, topicName=TET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cc52251, createdName=yhy100200, createdTime=Fri Jan 29 12:46:00 CST 2016, time=2016-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1796555, encodeId=faad1e96555f6, content=<a href='/topic/show?id=57211812121' target=_blank style='color:#2F92EE;'>#Ultra#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18121, encryptionId=57211812121, topicName=Ultra)], attachment=null, authenticateStatus=null, 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href='/topic/show?id=a8941812471' target=_blank style='color:#2F92EE;'>#ultrasound#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18124, encryptionId=a8941812471, topicName=ultrasound)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2cc329519145, createdName=linlin2322, createdTime=Fri Feb 05 01:46:00 CST 2016, time=2016-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1656663, encodeId=e0011656663c6, content=<a href='/topic/show?id=3ca31e71903' target=_blank style='color:#2F92EE;'>#TRA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17719, encryptionId=3ca31e71903, topicName=TRA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=757b24868428, createdName=bsmagic9140, createdTime=Mon Apr 18 19:46:00 CST 2016, time=2016-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1794231, encodeId=06741e94231de, content=<a href='/topic/show?id=b1e916559bc' target=_blank style='color:#2F92EE;'>#Sound#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16559, encryptionId=b1e916559bc, topicName=Sound)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=10ba218, createdName=zgwhgch, createdTime=Thu Oct 01 19:46:00 CST 2015, time=2015-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1740306, encodeId=a2601e4030627, content=<a href='/topic/show?id=f9f383688d0' target=_blank style='color:#2F92EE;'>#胎龄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83688, encryptionId=f9f383688d0, topicName=胎龄)], attachment=null, 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    2015-06-16 huangdf
  6. 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  7. 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2016, time=2016-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1794231, encodeId=06741e94231de, content=<a href='/topic/show?id=b1e916559bc' target=_blank style='color:#2F92EE;'>#Sound#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16559, encryptionId=b1e916559bc, topicName=Sound)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=10ba218, createdName=zgwhgch, createdTime=Thu Oct 01 19:46:00 CST 2015, time=2015-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1740306, encodeId=a2601e4030627, content=<a href='/topic/show?id=f9f383688d0' target=_blank style='color:#2F92EE;'>#胎龄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83688, encryptionId=f9f383688d0, topicName=胎龄)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f53c34728820, createdName=ms8538335253054589, createdTime=Wed Jul 08 06:46:00 CST 2015, time=2015-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1756725, encodeId=c22e1e5672533, content=<a href='/topic/show?id=20f846859f8' target=_blank style='color:#2F92EE;'>#小于胎龄儿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46859, encryptionId=20f846859f8, topicName=小于胎龄儿)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=887337209203, createdName=ms3117646317107274, createdTime=Sun Jan 24 22:46:00 CST 2016, time=2016-01-24, status=1, ipAttribution=)]
    2016-04-18 bsmagic9140
  8. 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2016, time=2016-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1794231, encodeId=06741e94231de, content=<a href='/topic/show?id=b1e916559bc' target=_blank style='color:#2F92EE;'>#Sound#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16559, encryptionId=b1e916559bc, topicName=Sound)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=10ba218, createdName=zgwhgch, createdTime=Thu Oct 01 19:46:00 CST 2015, time=2015-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1740306, encodeId=a2601e4030627, content=<a href='/topic/show?id=f9f383688d0' target=_blank style='color:#2F92EE;'>#胎龄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83688, encryptionId=f9f383688d0, topicName=胎龄)], attachment=null, 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    2015-10-01 zgwhgch
  9. 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  10. 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