VEGF和β-HCG与输卵管妊娠滋养细胞侵入管壁深度的关联性研究

Vascular endothelial growth factor and β-human chorionic gonadotropin are associated with trophoblastic invasion into the tubal wall in ectopic pregnancy

目的评估输卵管壶腹部妊娠患者滋养细胞浸润输卵管壁深度与血管内皮生长因子（VEGF）及β-人绒毛膜促性腺激素（B—HcG）血清浓度之间的关联性。方法选择输卵管壶腹部妊娠且已行患侧输卵管切除术患者80例。手术当天检测血清YEGF和B～HCG浓度。血清YEGF含量的测定采用EUSA法。留取切除的患侧输卵管及妊娠组织，输卯管肌纤维用Masson染色，滋养细胞用人胎盘催乳素（HPL）免疫组织化学染色。依据术后病理结果中滋养细胞浸入输卵管壁的深度，将80例患者分为I-Ⅲ期。血清B—HCG采用双抗体夹心光化学测定法。结果I期血清VEGF和B—HCG浓度的平均值明显低于Ⅱ期，而Ⅱ期明显低于Ⅲ期（P〈0．05）。I期和Ⅱ期临界值VEGF浓度为308．6ng／L，敏感度100．0％，特异度92．6％，Ⅱ期和Ⅲ期临界值VEGF浓度为431．9ng／L，敏感度79．3％，特异度79．2％；I期和Ⅱ期临界值p—HCG浓度为2509．6IU／L，敏感度91．7％，特异度81．5％，Ⅱ期和Ⅲ期临界值p—HCG浓度为13142．6IU/L，敏感度72．4％，特异度95．8％。结论输卵管妊娠患者血清中的VEGF和B—HCG浓度与滋养细胞浸润输卵管壁深度有关，可作为妊娠滋养细胞浸润输卵管管壁深度组织学分期的评估指标。

Objective To assess the association between the depth of trophoblastic penetration into the tubal wall with serum concentrations of vascular endothelial growth factor （VEGF） and β-human chorionic gonadotropin （13-HCG）. Methods Eighty patients with a diagnosis of tubal pregnancy in the ampullary region underwent radical surgical treatment （sal- pingectomy）, were included in this study. The serum levels of VEGF and β-HCG were detected on the day of surgery. The serum level of VEGF was measured by ELISA. The serum level of β-HCG was quantified with a two-site immnnofluorimetric assay based on the direct sandwichtechnique. Histological material was stained with Masson＇s trichrome to identify muscular fibers. Immunohistochemical staining was used for human placental lactogen （hPL） to identify intermediate trophoblast and determine the depth of trophoblastic invasion into the tubal wall. The ampullary pregnancies were classified histologically according to the depth of trophoblastic infiltration into the tubal wall. Results The mean serum values of VEGF and β-HCG were significantly lower in patients with stage I tubal infiltration than those of stage Ⅱ, and which were significantly lower in patients with stage Ⅱ than those in stageⅢ （P 〈 0.05）. The threshold serum value of VEGF was 308.6 ng/L, the sensitivity was 100.0% and the specificity was 92.6% for stage I and stage Ⅱ. The threshold serum value of VEGF was 431.9 ng/L, the sensitivity was 79.3% and specificity was 79.2% for stage Ⅱand m. The threshold serum value of β-hCG was 2 509.6 IU/L, the sensitivity was 91.7% and specificity was 81.5% for stage I and stage Ⅱ, and levels of 13 142.6 IU/L, 72.4% and 95.8% for stage Ⅱ and stage m. conclusion The depth of trophoblastic penetration into the tubal wall is associated with maternal serum concentrations of VEGF and β-HCG, which can be used as the evaluation index for histological staging of trophoblastic tissue infiltration.