持续性真性低水平人绒毛膜促性腺激素升高6例临床特点

Clinical Characteristics of Six Patients with Persistent Real Low-level Elevation of Human Chorionic Gonadotropin

目的探讨持续性真性低水平人绒毛膜促性腺激素(human chorionic gonadotropin,h CG)升高患者的临床特点和诊治意义。方法 2011年8月至2015年3月北京协和医院诊断为持续性真性低水平h CG升高患者6例,收集患者临床资料,对疾病特点、诊治过程和随诊情况进行回顾性分析。结果 6例患者中,3例继发于葡萄胎清宫术后,3例继发于侵蚀性葡萄胎化疗后。3例侵蚀性葡萄胎患者的中位总疗程数为8个,均有化疗失败史。6例患者随诊中位时间为24个月,自治疗结束至h CG呈低水平升高的中位时间为5.5个月,低水平h CG升高持续的中位时间为16.5个月。4例患者病情稳定,1例进展为绒毛膜癌,1例自然妊娠分娩后h CG降至正常。结论持续性真性低水平h CG升高的持续时间较长,对化疗不敏感,应密切随诊,不宜治疗。

Objective To investigate the clinical characteristics and significance of diagnosis and treat -ment associated with persistent real low-level elevation of human chorionic gonadotropin （ hCG） .Methods Six patients diagnosed with persistent real low-level hCG elevation at Peking Union Medical College Hospital in the period from August 2011 to March 2015 were collected .Clinical records of the 6 patients were reviewed to retro-spectively analyze clinical features , diagnosis and treatment approaches , and follow-up results.Results Among the 6 patients , 3 were secondary to uterine curettage for hydatidiform moles , and the other 3 had received chemo-therapy for invasive moles , in whom the median chemotherapy cycle number was 8 and all experienced failure of at least one chemotherapy regimen .The median follow-up time was 24 months.The median period between the termination of treatment and the initial low-level hCG elevation was 5.5 months.The median duration of low-level hCG elevation was 16.5 months.Four patients had no evidence of progression , 1 patient progressed to choriocar-cinoma, and 1 presented with the hCG level decreasing to the normal range after spontaneous delivery .Conclu-sion Persistent real low-level hCG elevation may persist for a long time and not respond to chemotherapy .Long-term close monitoring is necessary , but treatment is not recommended .