title: Diagnostic value of ultrasonographic combining biochemical markers for Down syndrome screening in first trimester: a meta-analysis.
abstract: OBJECTIVE
  The meta-analysis was to determine the diagnostic value of the combining tests for Down syndrome and to evaluate their utilities in the Down syndrome screening.
  
  
  METHODS
  Through comprehensive literature search, 24 studies met the inclusion criteria and were included in the databases (PubMed, Wed of knowledge, Chinese National Knowledge Infrastructure (CNKI)). Summary estimates for sensitivity and specificity were calculated by using the bivariate random effect model. The summary receiver operating characteristic curve was also undertaken.
  
  
  RESULTS
  The overall sensitivity and specificity of the combination of NT and free β-hCG and PAPP-A for Down syndrome were 0.86(95%CI 0.75-0.92) and 0.96(95%CI 0.95-0.97), respectively. The summary positive likelihood ratio and negative likelihood ratio were 23.3 (95%CI 16.7-32.5) and 0.15(95%CI 0.08-0.26), respectively. The pooled diagnostic odds ratio was 156 (95%CI 75-326).
  
  
  CONCLUSIONS
  The meta-analysis shows the accumulative evidence for the clinician that the performance of the combined test of MA and NB and NT and PAPP-A and free β-hCG is the most effective test in the four different combined tests, while, the combination of NT and PAPP-A and free β-hCG is a cost-effective screening tool for Down syndrome.
authors.affiliation: Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong Province, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong Province, China.
authors.forename: Xingguang
authors.initials: X
authors.lastname: Ye
authors.affiliation: Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong Province, China.
authors.forename: Na
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong Province, China.
authors.forename: Baohuan
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong Province, China.
authors.forename: Congcong
authors.initials: C
authors.lastname: Guo
authors.affiliation: Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong Province, China.
authors.forename: Weihuang
authors.initials: W
authors.lastname: Huang
authors.affiliation: Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong Province, China.
authors.forename: Lipeng
authors.initials: L
authors.lastname: Jing
authors.affiliation: Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong Province, China.
authors.forename: Man
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Parasitology, School of Medicine, Jinan University, Guangzhou, Guangdong Province, China.
authors.forename: Guang
authors.initials: G
authors.lastname: Yang
authors.affiliation: Family Planning Research Institute of Guangdong, Guangzhou, Guangdong Province, China.
authors.forename: Xiangcai
authors.initials: X
authors.lastname: Wei
authors.affiliation: Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, Guangdong Province, China.
authors.forename: Chunxia
authors.initials: C
authors.lastname: Jing
mesh_terms: D015415:Biomarkers / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D004314:Down Syndrome / Q000175:diagnosis*; D005260:Female; D006801:Humans; D062145:Maternal Serum Screening Tests; D015233:Models, Statistical; D048208:Nuchal Translucency Measurement; D016017:Odds Ratio; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood*; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D018997:Chorionic Gonadotropin, beta Subunit, Human; D011266:Pregnancy-Associated Plasma Protein-A