Integratsiyalashgan 1
Kod:9052|CPT:84163|LOINC:49586-1, 11957-8, 34970-4, 49089-6, 18185-9, 43993-5, 21484-1, 29463-7, 11878-6, 12146-7, 48407-1, 77202-0, 11502-2
| Kabi | Crown–rump uzunligi Crown–rump uzunligi (egizak B) CRL skan CRL skan (egizak B) Bo‘yin shaffofligi (NT) Bo‘yin shaffofligi (egizak B) PAPP‑A qiymati |
|---|
Tahlil ma'lumotlari
Tadqiqot usuli
- Kimyoluminessent immunoanaliz (CLIA)
- Sendvich immunoanaliz
Kutilayotgan natija topshirish vaqti
1 kun
Maxsus tayyorlik
- Submit nuchal translucency and crown–rump length measurements obtained by a credentialed sonographer and include the sonographer’s certification number.
- Provide maternal race, weight, date of birth, insulin‑dependent diabetes status, number of fetuses, and relevant obstetric history.
- Collect serum between 10.0 and 14.0 weeks of gestation; assess nuchal translucency when crown–rump length is 45–84 mm.
- Avoid fatty foods for 24 hours before the blood draw.
- Refrain from vigorous physical or emotional stress and do not smoke for 30 minutes prior to collection.
Qanday foydalanish
Integratsiyalashgan 1 testi (homiladorlik bilan bog‘liq plazma oqsili A, PAPP‑A; pappalizin 1 nomi bilan ham tanilgan) birinchi trimestrdagi integratsiyalashgan prenatal skriningda Daun sindromi, 18‑trizomiya va ochiq nerv naychasi nuqsonlari ehtimolini baholash uchun qo‘llanadi. Ona zardobidagi o‘lchov bo‘yin shaffofligi va boshqa klinik ma’lumotlar bilan birga talqin qilinadi, yakuniy xavf hisob‑kitobi esa ikkinchi trimestr namunasidan so‘ng beriladi; bu skrining vositasi bo‘lib, diagnostik emas. Ona zardobidagi PAPP‑A bo‘yin shaffofligi va klinik parametrlar bilan birgalikda ko‘rib chiqilganda nojo‘ya homiladorlik oqibatlari xavfini kontekstualizatsiya qilishi mumkin, biroq u mustaqil diagnoz qo‘yish uchun mo‘ljallanmagan.
Cheklovlar
Homiladorlik bilan bog‘liq plazma oqsili A (PAPP‑A) — sink bilan bog‘lanadigan metalloproteinaza bo‘lib, platsenta trofoblasti va detsidua tomonidan sintezlanadi hamda ona qoniga yirik molekulyar og‘irlikdagi kompleks ko‘rinishida chiqariladi. PAPP‑A insulin‑o‘xshash o‘sish omilining bog‘lovchi oqsillarini parchalab, IGF ning biofoydalanishini oshiradi va shu orqali platsenta o‘sishini qo‘llab‑quvvatlaydi; shuningdek, ayrim aylanuvchi proteazalarni inaktivatsiya qilishi va ona immun javoblarini modulyatsiya qilishi mumkin. Ona zardobidagi konsentratsiyalar homiladorlik davom etishi bilan ortadi va platsentatsiya davrida (7–14‑haftalar) estradiol bilan korrelyatsiyalanadi. 8–14 haftalar oralig‘ida PAPP‑A pasaygan darajalari xromosomal anevploidiyali (eng ko‘zga tashlanadigani 21‑, 18‑ va 13‑trizomiyalar) homilalarda kuzatiladi; ko‘p anomaliyalar bilan kechuvchi sindromlarda, masalan, Cornelia de Lange sindromida darajalar keskin past bo‘lishi mumkin. PAPP‑A birinchi trimestrda bo‘yin shaffofligi bilan birga talqin qilinadi va integratsiyalashgan protokol doirasida odatda ikkinchi trimestr markerlari bilan kombinatsiya qilinadi; yagona marker sifatida u 8–9 haftalarda eng axborotli, 14 haftadan keyin esa anevploidiyaga xavf bahosidagi qiymati kamayadi. Birinchi trimestrda PAPP‑A pastligi homiladorlik asoratlari xavfining oshishi bilan bog‘liq. Integratsiyalashgan skrining ikki namuna (birinchi va ikkinchi trimestr) ni o‘z ichiga oladi va xavf baholari ikkalasi ham yakunlanganda beriladi. Ushbu yondashuv skrining uchun mo‘ljallangan; ijobiy natijalar diagnostik tasdiqlashni talab qiladi, masalan, xorion villusi namunasi (chorionic villus sampling) yoki amniotsentez va genetik tahlil. Homilador bo‘lmagan shaxslarda PAPP‑A iz miqdorda mavjud bo‘lishi mumkin, va o‘tkir koronar sindromlarda ateromatoz blyashka buzilishidan so‘ng ko‘tarilishi kuzatiladi, biroq u rutinni kardiologik testlashda keng qo‘llanmaydi.
| O'lchov birligi | ng/mL | ||||
|---|---|---|---|---|---|
| Referens oraliq |
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| Ko'rsatmalar | Aneuploidy risk assessment in the first trimester (10–13 weeks' gestation) |
Natija og'ishlarining mumkin sabablari
Oshgan daraja
- gestational age misclassification
- multiple gestation
Pasaygan daraja
- gestational age misclassification
Namunangiz talablari
| Namunangiz | Zardob |
|---|---|
| Container | Oltin/yo'lbars qopqoqli probirka (SST, gel ajratgich) |
| Hajm | 3 mL (min 1 mL) |
| Saqlash tayyorlik | Xona harorati, Sovutilgan, Muzlatilgan |
References
Wald NJ, Watt HC, Hackshaw AK. Integrated screening for Down's syndrome based on tests performed during the first and second trimesters. N Engl J Med. 1999;341(7):461-467. PMID: 10441601.
Gorin VS, Serov VN, et al. Pregnancy-associated plasma protein A and other macroglobulins as protein markers of perinatal pathology. Russian Bulletin of Perinatology and Pediatrics. 1998;4:18-24.
Body R, Ferguson C. Pregnancy associated plasma protein A: a novel cardiac marker with promise. Emerg Med J. 2006;23(11):875-877. PMCID: PMC2464389.
Brügger-Andersen T, Bostad L, et al. The activity of pregnancy-associated plasma protein A (PAPP-A) as expressed by immunohistochemistry in atherothrombotic plaques obtained by aspiration thrombectomy in patients presenting with a ST-elevation myocardial infarction: a brief communication. Thromb J. 2010;8(1):1. PMID: 20181026.