血清<em>β</em>-hCG水平动态变化与滋养细胞侵入输卵管壁深度的相关性研究-东南大学学报医学版

血清β-hCG水平动态变化与滋养细胞侵入输卵管壁深度的相关性研究

单位：湖南省妇幼保健院, 湖南长沙 410008

分类号：R714.22

出版年·卷·期（页码）：2015·34·第五期（754-757）

摘要：

目的:研究输卵管妊娠患者血清β-hCG水平动态变化与滋养细胞侵入输卵管壁深度的关联性,为临床治疗输卵管妊娠提供参考。方法:检测110例患侧输卵管切除的输卵管壶腹部妊娠患者术前48 h和手术当天的血清β-hCG水平,术后病理检查确定滋养细胞侵入输卵管壁的深度,采用Kruskal-Wallis H检验进行统计分析。结果:36例Ⅰ期(滋养细胞侵入黏膜层)输卵管妊娠患者48 h血清β-hCG水平平均降低18.35%,32例Ⅱ期(侵入肌层)患者血清β-hCG水平平均升高31.95%,42例Ⅲ期(侵入浆膜层)患者血清β-hCG水平平均升高37.55%,3组间差异具有统计学意义(P<0.05)。Ⅰ期患者β-hCG水平降低幅度低于Ⅱ期和Ⅲ期患者升高幅度,Ⅱ期患者升高幅度低于Ⅲ期患者(P<0.05)。结论:输卵管妊娠患者术前48 h血清β-hCG水平变化程度与滋养细胞侵入输卵管壁深度呈正相关,其可以作为临床上滋养细胞浸润程度判断的一项参考指标。

Objective: To study the correlation between the dynamic changes of serum β-hCG and trophoblast cells invasion depth into the tubal wall in patients with tubal pregnancy in order to provide a reference for the clinical treatment of tubal pregnancy. Methods: 110 patients with tubal pregnancy treated in our hospital between April 2013 and April 2014 were recruited; and their serum β-hCG concentrations 48 h and 0 h before the operations, and the results of tests of trophoblast cells invasion depth into the tubal wall were collected. The data was analyzed by H test. Results: On average, among th 36 patients of stage Ⅰ(invasive depth to mucous layer),the level of serum β-hCG 48 h before the opeprations droped to 18.35%; for stage Ⅱ(invasive depth to muscle layer) patients the level grows by 31.95%, and for patients of stage Ⅲ(invasive depth to serosa) the level growed by 37.55%. The difference was significant among the groups(P<0.05). The reduced degrees of serum β-hCG in stage Ⅰ patients were lower than increased degrees in stage Ⅱ and stage Ⅲ patients, and the increased degrees in stage Ⅱ patients were lower than in stage Ⅲ patients(P<0.05). Conclusion: The preoperative change degree of serum β-hCG is positively correlated with trophoblastic invasion depth into the tubal wall in patients with tubal pregnancy. It could be used as a reference index to judge the extent of trophoblast cell infiltration in clinical practice.

参考文献：

[1] 唐龙英,徐东英,倪倩,等.异位妊娠发病趋势和临床诊治分析[J].实用妇产科杂志,2012,28(9):789-792.
[2] 汪向红.药物、保守手术、根治手术治疗输卵管妊娠疗效比较[J].山东医药,2011,51(6):48-49.
[3] 马慧娟,李巍.血清β-hCG值与滋养细胞浸润输卵管壁深度的相关性研究[J].中国妇幼保健,2011,26(18):2876-2877.
[4] 张振东,孙丽君,罗莹,等.应用ROC曲线评价血清β-hCG、黄体酮和子宫内膜厚度对异位妊娠的诊断价值[J].重庆医学,2011,40(26):2622-2624.
[5] 田加珍,朱彗央.早期异位妊娠的血清β-HCG和孕酮的变化及临床意义[J].实用预防医学,2013,20(11):1352-1354.
[6] BORA S A,KIRK E,DAEMEN A,et al.Is serum human chorionic gonadotrophin follow-up necessary after suspected spillage of trophoblast at the time of laparoscopic surgery for ectopic pregnancy?[J].Gynecol Obstet Invest,2011,71(4):225-228.
[7] FERREIRA D F,ELITO J J,ARAUJO J E,et al.Trophoblastic infiltration in tubal pregnancy evaluated by immunohistochemistry and correlation with variation of Beta-human chorionic gonadotropin[J].Pathol Res Int,2014,2014(26):30-34.
[8] 谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:122-124.
[9] 张红霞,曾倩,崔潇华,等.输卵管妊娠患者血清β-人绒毛膜促性腺激素水平与滋养细胞对输卵管浸润深度相关性分析[J].中国医药导报,2011, 8(36):57-58.
[10] 秦伟,胡天刚,曾于,等.输卵管妊娠的非血管介入治疗[J].现代医学, 2009,37(4):314-316.
[11] 刘宁.血清β-HCG、尿HCG、B超检测诊断异位妊娠的价值[J].中国妇幼保健,2007,22(21):3022-3023.
[12] NATALE A,CANDIAN M,MERIO D,et al.Human chorionic gonadotropin level as a predictor of trophoblast infiltration into the tubai wallin ectopic pregnancy.A blinded study[J].Fertil Steril,2003, 79(4):981-986.
[13] KLEIN M,GRAF A,KISS A,et al.Impact of trophblast penetration through the basal membrance on the efficacy of drug therapy in tubal pregnancy[J].Hum Reprod,1995,10(2):439-441.
[14] JOB S N,FEMANDEZ H,BOUYER J,et al,Ruptured tubal ectopic pregnancy:risk factors and reproductive outcome:results of a population-based study in France[J].AM J Obstet Gynecol,1999, 180(4):938-944.
[15] 李雪英,张怡,聂长庆,等.输卵管妊娠时血清β-hCG水平与滋养细胞侵入输卵管壁深度关系的研究[J].实用妇产科杂志,2006,22(1):40-42.
[16] CABAR F R,PEREIRA P P,SCHULTZ R,et al.Predictive factors of trophoblastic invasion into the ampullary region of the tubal wall in ectopic pregnancy[J].Hum Reprod,2006,21(9):2426-2431.
[17] 陆燕婷,汪太松.血清β-HCG和P联合检测在早期异位妊娠诊断中的价值[J].标记免疫分析与临床,2011,18(5):305-308.
[18] RDA C S,JUNIOR J E,CAMANO L.Increment in β-hCG in the 48-h period prior to treatment:a new variable predictive of therapeutic success in the treatment of ectopic pregnancy with methotrexate [J].Arch Gynecol Obstet,2008,278(4):319-324.
[19] ELITO J J,CAMANO L.Unruptured tubal pregnancy: different treatments for early and late diagnosis[J].Sao Paulo Med J, 2006,124(6):321-324.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录