| Objective:The aim of this study was to screen the research papers that met the inclusion criteria in the last 5 years by Meta-analysis method,summarize the data in them,and obtain a valid assessment basis as an important reference for our evaluation of Noninvasive Prenatal Test NIPT technology in chromosomal aneuploidy detection in twin pregnancies,expecting to provide clinicians with safer,more accurate and efficient diagnostic recommendations to clinicians.Methods:After systematically summarizing data from multiple research units and analyzing them in depth.2.By searching multiple databases from January 1,2017 to October 1,2022,included in China Knowledge Network,Wanfang Medical Network,Pub Med,CBM,Cochrane,Embase,and Vibe and Web of science etc,regarding noninvasive prenatal screening in studies on the application of noninvasive prenatal screening in twin pregnancies,and analyzed the relevant literature on its sensitivity,specificity,false-positive rate and false-negative rate.3.The midas command of Stata15.0 and Review Manager 5.3 were used for stratification analysis of chromosomal aneuploidy.The specificity Q test was used to test the differences between types using I~2as a quantitative indicator.Meta-regression analysis was used to explore different data sources and eliminate data with significant differences.Deek’s test was used to assess whether the study information was reliable.Results:After screening of the literature management software,a total of 13papers were finally included,all of which were cohort studies,including 9studies with risk of bias in four areas:inclusion of patients,testing criteria,reference criteria and process and testing schedule,with the greatest risk of bias especially in selection.All twin pregnancies included in the study totaled 10,766 and were screened with NIPT,including 86 with 21-trisomy,with a positive screening rate of 0.79%(86/10766),30 with 18-trisomy,with a positive screening rate of 0.28%(30/10766),and 3 with 13-trisomy,with a positive screening rate of 0.03%(3/10766).There were 76 cases of trisomy 21 confirmed by gold standard(amniocentesis or karyotyping by cord blood aspiration and postnatal follow-up),with a positive rate of0.71%(76/10756),6 false positives,0.06%(6/10106),2 missed cases,2.6%(2/76),and 4 missed cases.29 cases of trisomy 18,with a positive screening rate of 0.30%(29/10765).0.30%(29/10765),1 false-positive case,0.01%(1/9634),3 missed cases,10.3%(2/29)false-negative rate.3cases of trisomy 13,0.03%(3/10766),2 false-positive cases,0.02%(2/10106)false-positive rate,and 1 true-negative case.The accuracy and reliability of the study results were evaluated by combining the data from the included study samples to draw the subject operating characteristic curve(SROC)and calculate the area under the curve(AUC).With the detection of 13-trisomers we found that although some positive validation has been obtained,there is still a lack of sufficient samples to make an objective evaluation of its accuracy,reliability and its efficiency.Conclusion:1.The accuracy of the NIPT technique for screening both T21 and T18 in twin pregnancies is high and even exceeds that of conventional prenatal screening techniques.2.For T13,due to its relatively low sample size and positive rate,more optimization of its technique is needed for us to perform prenatal screening of twin pregnancies more effectively,and therefore,its detection efficacy cannot be determined yet.3.When performing NIPT screening tests,especially in twin pregnancies,factors that affect the accuracy of NIPT screening should be avoided as much as possible,such as choosing the appropriate time window for testing and weight management during pregnancy to ensure the accuracy of screening.4.For twin pregnancies with a high risk of NIPT screening,further interventions should be performed for prenatal diagnosis. |
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