19 неделя беременности, двойня. Завышен АФП и бета ХГ

[Keeptry]

АФП 132 (норма 22-85)
бета ХГ - 93520 (норма 10000-35000)
Е3 - 13.9 (норма 3-30)
17ОП - 20.8 (норма 6.1-14.1)

Жена принимала дюфастон и дексаметазон

Нормально ли это для двойни?
Жена очень переживает.

[Dr.Vad]

Ув. Keeptry,
в среднем при двойне АFP в 2,1 раза выше от нормы при монобеременности, а своб. hCG в 2.07-2.16, сравнивать нужно же не с нормой, а со средними величинами, характерными для обычной беременности в определенные сроки.
Относительное повышение ХЧГ и относительное понижение АФП может иметь место для ранней диагностики синдрома Дауна, но здесь нужно учитывать и возраст и др. показатели.
Ист. знаний:
Prenat Diagn. 2003 Apr;23(4):331-5.
Second-trimester Down syndrome maternal serum screening in twin pregnancies: impact of chorionicity.
Muller F, Dreux S, Dupoizat H, Uzan S, Dubin MF, Oury JF, Dingeon B, Dommergues M.
Biochimie, Hopital Ambroise Pare, Boulogne, France.
OBJECTIVE: To evaluate the diagnostic value of second-trimester maternal serum screening for Down syndrome in twin pregnancies. METHOD: On the basis of a prospective study of second-trimester maternal serum screening, we studied the distribution of alpha-fetoprotein (AFP) and free ss hCG in 3043 twin pregnancies with known outcome. There were 1561 dichorionic and 244 monochorionic pregnancies. The placental type was not available in 1238 cases. We compared 5 screening policies with the same risk, 1/250, cut-off: maternal age, maternal age corrected for the risk of having at least one affected twin in dichorionic pregnancies, maternal serum marker screening using observed AFP and free ss-hCG values divided by a factor of 2, by using the median values actually observed in the global twin population, or by the median values specific to mono- or dichorionic twins. RESULTS: When expressed in singleton-derived MoMs, the median was 2.10 for AFP and 2.11 for free ss-hCG. The median AFP did not differ between monochorionic and dichorionic pregnancies. The distribution of free ss-hCG was significantly shifted towards greater values in monochorionic (2.16 MoM) compared to dichorionic (2.07) pregnancies (p < 0.0001). Screened-positive and detection rates were, respectively, 6.6% and 27.3% using maternal age alone, 24.6% and 54.5% using maternal age corrected for the risk of having at least one affected twin in dichorionic pregnancies, 7.75% and 54.5% using observed AFP and free beta-hCG values divided by a factor of 2, 8.05% and 54.5% using the median values actually observed in the global twin population, and 7.75% and 54.5% using the median values specific to mono- or dichorionic twins. CONCLUSION: Trisomy 21 second-trimester maternal serum screening is feasible in twins, and is better than a policy based on maternal age alone.

Prenat Diagn. 1994 Jul;14(7):537-42.
Down's syndrome screening in multiple pregnancies using alpha-fetoprotein and free beta hCG.
Spencer K, Salonen R, Muller F.
Clinical Biochemistry Department, Oldchurch Hospital, Romford, Essex, U.K.
Second-trimester distributions of the free beta human chorionic gonadotrophin (hCG) and alpha-fetoprotein (AFP) levels in 420 twin and 19 triplet pregnancies were measured and compared with the distributions in 6661 singleton pregnancies. On average, the levels of both analytes were twice as high and over three times as high in triplets. Eight sets of twins discordant for Down's syndrome showed elevated levels of free beta hCG and reduced levels of AFP after correction of the multiple of the median for the presence of a twin pregnancy. Screening for Down's syndrome using the twin correction of the multiple of the median is expected to achieve a 51 per cent detection rate at a 5 per cent false-positive rate using these two markers.

[Keeptry]

Очень поучительно, только вот вопрос - в данном конкретном случае есть причины для беспокойства или нет?
Ей 30 лет, первая беременность. На УЗИ патологий не обнаружено.

Я по образованию не врач (физик) и возможно мой вопрос тупой, за что заранее извиняюсь

[Dr.Vad]

Нет, вопрос даже для медика не тупой, ибо ответ на него может дать лишь тот спец, кто Вашу жену на эти анализы отправил, у которого надеюсь есть и нормальные величины этих показателей для 19 недель и ее массы тела, и таблица позволяющая рассчитать риск появления трисомии 21, иначе зачем было вообще эти анализы сдавать?