论文部分内容阅读
目的探讨B超检测NT联合母体血清F-β-HCG、PAPP-A筛查孕早期胎儿唐氏综合征的诊断价值。方法计算机检索维普中文科技期刊数据库、中国期刊全文数据库、万方数据库、中国生物医学文献数据库、Pubmed,Embase and Cochrane Library Databases等(时间截止到2012年9月),获得B超测NT联合母体血清F-β-HCG、PAPP-A筛查孕早期胎儿唐氏综合征的文献。采用QUADAS工具对收纳文献进行质量评价。采用Metadisc1.4软件,计算灵敏性、特异性及95%CI,并描绘受试者工作特性曲线(SROC),计算曲线下面积(AUC),并进行敏感性分析。采用Stata/SE12.0绘制Deeks漏斗图计算发表性偏倚。结果符合纳入标准文献23篇进入Meta分析,汇总灵敏度和特异度分别为0.89(95%CI:0.88%~0.90)及0.96(95%CI:0.96%~0.96)。经异质性检验发现存在非阈值效应引起的异质性,故行亚组分析。当危险界值>1∶300时,灵敏度可达91%(95CI:88%~93%),特异度可达95%(95%CI:95%~95%);当危险界值>1∶270时,灵敏度为88%(95%CI:82%~93%),特异度为95%(95%CI:94%~95%);当危险界值>1∶250时,灵敏度可达81%(95%CI:77%~84%),特异度可达95%(95%CI:96%~96%);当危险界值>1∶200时,灵敏度可达89%(95%CI:86%~92%),特异度可达95%(95%CI:95%~95%);当危险界值>1:100时,汇总灵敏度和特异性分别为灵敏度可达92%(95%CI:90%~93%),特异度可达97%(95%CI:97%~97%)。合并以上分组的汇总SROC AUC为0.981,Q指数为0.940。结论 B超测NT联合母体血清F-β-HCG、PAPP-A能显著提高筛查胎儿唐氏综合征准确性,有助于孕早期诊断胎儿唐氏综合征。
Objective To investigate the value of B-ultrasound in the detection of F-β-HCG and PAPP-A in the screening of fetal Down Syndrome in early pregnancy. Methods We searched the databases of VIP Chinese Science and Technology Periodicals, Chinese Journal Full-text Database, Wanfang Database, Chinese Biomedical Literature Database, and so on (by September 2012) F-β-HCG, PAPP-A screening for early pregnancy fetal Down Syndrome literature. QUADAS tools were used to assess the quality of accepted documents. The Metadisc 1.4 software was used to calculate sensitivity, specificity, and 95% CI. Subject performance curves (SROC) were plotted, area under the curve (AUC) calculated, and sensitivity analyzed. A Deeks funnel plot was plotted using Stata / SE12.0 to calculate published bias. Results All the 23 patients who met the standard were included in the Meta analysis. The pooled sensitivity and specificity were 0.89 (95% CI: 0.88% -0.90) and 0.96 (95% CI: 0.96% -0.96), respectively. Heterogeneity test found that there is heterogeneity caused by non-threshold effect, so the line subgroup analysis. Sensitivity can reach 91% (95CI: 88% -93%) and specificity of 95% (95% CI: 95% -95%) when the cutoff value is> 1: 300. 270, the sensitivity was 88% (95% CI: 82% -93%) and the specificity was 95% (95% CI: 94% -95%). Sensitivity was 81 when the cutoff value was> 1: 250 (95% CI: 77% -84%), with a specificity of 95% (95% CI: 96% -96%), with a sensitivity of 89% (95% CI : 95% CI: 95% -95%); when the cutoff value is> 1: 100, the sensitivity and specificity of the pooled sensitivity are up to 92% (95% CI: 95% % CI: 90% ~ 93%), specificity of up to 97% (95% CI: 97% ~ 97%). The combined SROC AUC for the combined subgroups was 0.981 and the Q index was 0.940. Conclusion B-ultrasound NT combined with maternal serum F-β-HCG and PAPP-A can significantly improve the accuracy of screening Down’s syndrome in fetuses and help to diagnose fetal Down’s syndrome in early pregnancy.