探讨人胎盘泌乳素(HPL)标记中间滋养细胞在宫内外妊娠中的价值

Clinical Value of Detection of HPL-Expressing Intermediate Trophoblasts in Abortion or Curettage-Obtained Specimens for Diagnosis of Intrauterine or Ectopic Pregnancies

目的:探讨HPL标记中间滋养细胞的诊断价值,籍以协助诊断宫内孕或宫外孕。方法:1组:选择蜕膜中疑似中间滋养细胞植入标本35例;Ⅱ组:宫内膜间质细胞肥硕呈蜕膜样变及/或宫内膜腺上皮呈A-S现象标本30例。对照组:宫内孕标本30例。对上述二组应用免疫组化SP法测定HLP,试剂选自福州迈新公司,染色结果以阳性细胞百分比及着色深浅综合判定。结果:对照组30例宫内孕具备蜕膜及绒毛,有24例HPL(+),6例(-)。Ⅰ组35例蜕膜组织疑似中间滋养细胞(IT)植入,28例HPL(+),证实为宫内孕;7例(-),证实2例为宫内孕,5例为宫外孕。Ⅱ组30例蜕膜样组织伴或不伴A-S现象,其中HPL 22例(+)均为宫内孕,8例(-),证实6例为宫外孕,2例为宫内孕。结论:1组和2组HPL(+)测定种植型中间滋养细胞对诊断宫内孕发生率高达50/65例(76.9%)及宫外孕11/65例(16.9%),HPL(-)11/15例(73.3%)为宫外孕及4/15(26.7%)为宫内孕,具有重要的临床诊断价值。

Objective To investigate the value of detection of HPL - expressing intermediate trophoblasts in endometrial specimens for diagnosis of intrauterine and ectopic pregnancies. Methods The examined specimens included ： ①Group Ⅰ , 35 specin,ens with suspected intermediate trophoblast in decidua ② Group Ⅱ, 30 specimens with decidua - like plump endometrial stroma cells and/ or A - S phenomena in glandular epithelium ③30 specimens from proven intrauterine pregnancies serving as controls. Histochemistry （ SP method） was used for HPL detection in all these specimens. Results In the 30 proven intrauteruine preganaies, decidua and villa were present in all the specimens. Only 24 of the 30 were found to be HPL（ ＋ ） with 6 HPL negatives （20%）. In Group I, 28 of the 35 specimens were found to be HPL（ ＋ ） and all of 28 were from intrauterine pregnancies. Of the 7 HPL negative cases, 5 were later confirmed as with ectopic pregnancy, the remaining 2 were with intrauterine pregnancy. In Group Ⅱ, 22 of 30 specimens were HPL（ ＋ ） and all were from intrauterine pregnancy. Of the 8 HPL negative cases, 6 were later confirmed as with ectopic pregancy and 2 were with intrauterine pregnancy. Combining the data from Group Ⅰ and Ⅱ, we could see that in the total 15 HPL negative cases, 11 were with ectopic pregnancy （ 11/15 =73.3% ） and 4 were with intrauterine pregnancy （4/15 =26.7% ）. Conclusion In specimens of intrauterine contents, demonstration of HPL（ ＋ ） cells could be regarded as confirmative evidence of intrauterine pregancy. However, the reverse did not hold true. Many of the HPL negative specimens were from intrauterine pregnanc!es （ in this study 4/15 or 26.7% ）. Therefore, in HPL negative cases, there was a high possibility of ectopic pregancy but further examinations were required to ascertain the diagnosis.