Xác định trung vị của các biomarker trong tầm soát lệch bội quý 1 thai kỳ tại Bệnh viện Đại học Y dược thành phố Hồ Chí Minh

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Tác giả: Thị Hương Xuân Nguyễn, Nhật Thăng Trần

Ngôn ngữ: vie

Ký hiệu phân loại: 174.25 Innovative procedures

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2021

Mô tả vật lý: Đại học Y dược TP. Hồ Chí Minh

Bộ sưu tập: Metadata

ID: 498065

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Low serum concentrations of pregnancy-associated plasma protein-A (PAPP-A) and increased levels of free β-human chorionic gonadotropin (fβ-hCG) at 11-13 weeks 6 days of pregnancy are associated with an increased risk of fetal Down syndrome (trisomy 21). Several studies indicated that the serum concentrations of PAPP-A and fβ-hCG present during pregnancy were different between ethnicities and the difference could not be compensated by weight correction. All ethnic groups should have their own reference ranges of these 2 serum biomarkers. Objective: to determine median level for serum levels of PAPP-A and fβ-hCG in the UMC population. Methods: The study reported a series of retrospective and prospective cases of 2873 pregnant women who visited the prenatal diagnosis unit of the University of Medicine and Pharmacy Hospital in Ho Chi Minh City was screened for the first trimester of pregnancy by combined test. Results: UMC reference ranges of PAPP-A and fβ-hCG were established by gestational age (77-97 days). The equation of best fit for PAPP-A was: predicted median PAPP-A level=214,3-5,384 x (gestational age in days) + 0,03415 x (gestational age in days)2
r=0,9677. The equation of best fit for fβ-hCG was: predicted median fβ-hCG level=10^ (-0,06799 x (gestational age in days) + 7,581)
r= 0,991. Weight-corrected models were also derived for each biomarker. PAPP-A MoM corrected= 0,3628*EXP(0,01705*weight Kg)
fβ-hCG MoM corrected = 1,665*EXP(-0,005857*weight Kg). The median MoM PAPP-A when using the UMC-specific model was 0,896, and the median MoM PAPP-A when using the FMF model was 1,064 (95% CI, p <
0.05). The median MoM fβ-hCG when using the UMC-specific model was 1,221, and the median MoM fβ-hCG when using the FMF model was 1,433 (95% CI, p<
0,05). The UMC-specific reference ranges gave higher positive screening rates than the FMF model, even after weight correction (8,8 % versus 7,62%).Thay đổi nồng độ PAPP-A và free beta-hCG (fβ-hCG) trong máu mẹ được chứng minh là có liên quan đến nguy cơ mắc hội chứng Down ở thai nhi. Một số nghiên cứu cho thấy trung vị hai chất này thay đổi theo chủng tộc và không thể giải thích được bằng hiệu chỉnh cân nặng mẹ. Mỗi dân tộc nên có giá trị tham chiếu riêng cho dân số mình. Mục tiêu: Xác định giá trị trung vị của PAPP-A và fβ-hCG của dân số đại học Y Dược Tp. Hồ Chí Minh (ĐHYD). Phương pháp: Nghiên cứu báo cáo loạt ca hồi và tiến cứu 2873 thai phụ đến khám tại đơn vị chẩn đoán trước sanh bệnh viện ĐHYD TP. Hồ Chí Minh được sàng lọc quí 1 thai kì bằng combined test. Kết quả: Trung vị dự đoán: PAPP-A=214,3 - 5,384 x (ngày tuổi thai) + 0,03415 x (ngày tuổi thai)2 r=0,9677
fβ-hCG = 10^ (-0,06799 x (ngày tuổi thai) + 7,581) r= 0,991
Mô hình điều MoM theo cân nặng mẹ: PAPP-A MoM hiệu chỉnh = 0,3628*EXP(0,01705*cân nặng Kg)
fβ-hCG MoM hiệu chỉnh = 1,665*EXP(-0,005857*cân nặng Kg)
Trung vị MoM PAPP-A khi sử dụng mô hình đặc trưng cho dân số ĐHYD là 0,896 khác biệt với trung vị MoM PAPP-A khi sử dụng mô hình của FMF là 1,064 (95% CI, p<
0.05). Trung vị MoM fβ-hCG khi sử dụng mô hình đặc trưng cho dân số ĐHYD là 1,221 khác biệt với trung vị MoM fβ-hCG khi sử dụng mô hình của FMF là 1,433 (95% CI, p<
0.05). So sánh hai mô hình: Tỉ lệ dương tính của test sàng lọc khi áp dụng MoM- FMF là 7,62%.Tỉ lệ dương tính của test sàng lọc khi áp dụng MoM-ĐHYD là 8,8%. Khi áp dụng MoM-ĐHYD: Tỉ lệ phát hiện là 100%. Tỉ lệ tiên đoán dương: 7,11%
Tỉ lệ dương giả: 8,18%. Kết luận: Mỗi chủng tộc nên áp dụng giá trị trung vị PAPP-A và fβ-hCG riêng của dân số mình cho sàng lọc lệch bội ba tháng đầu thai kì bằng combined test.

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