表现为持续性低水平人类绒毛膜促性腺激素的妊娠滋养细胞疾病六例

Gestational trophoblastic diseases presented with persistent low levels of hCG

目的 分析表现为持续性低水平人类绒毛膜促性腺激素(β-hCG)的妊娠滋养细胞疾病(GTD)的临床特点、诊断及治疗.方法 回顾性分析6例表现为持续性低水平β-hCG升高的GTD患者的临床资料并进行文献复习.结果 6例患者观察低水平β-hCG的时间为10～53个月,血清β-hCG值波动范嗣为3～637 U/L.末次妊娠性质5例为葡萄胎,1例为流产.葡萄胎后的5例患者接受了多次化疗,结束化疗后血清β-hCG维持正常1～12个月后又低水平回升,仅1例患者在病程第30个月出现肺部病灶,经手术和再次化疗后治愈,余4例及1例流产后患者在病程及随访中均无临床肿瘤证据,流产后患者未行治疗.结论 表现为持续性低水平β-hCG的GTD是一类特殊疾病,对化疗反应轻微,多数不发病,在无临床肿瘤证据时,给予治疗要慎重.

Objective To study the clinical characteristics, diagnosis, and treatment of patients with persistent low levels of β-hCG. Methods To analyze the clinical data of 6 patients with persistent low level of β-hCG retrospectively and review the relevant literature. Results The periods of low levels of β-hCG in the 6 patients were 10-53 months. The range of β-hCG was 3～637 U/L. The last pregnancy were hydatidiform mole in 5 cases and abortion in 1 case. After hydatidiform mole 5 cases were received multi-chemotherapy. Normal level of β-hCG maintained 1-12 months after chemotherapy, then β-hCG titer has gone up again, One patient developed lung metastases after 30 months and then cured by surgery and chemotherapy. There were no clinical evidence of malignancy in the other 4 cases, and 1 case received no therapy after abortion during course of therapy and following up. Conclusion Persistent low level of hCG was a special kind of disease with poor response to chemotherapy, but the majority were with stable status. Therapy should be restrained if there was no evidence of malignancy.