血人绒毛膜促性腺激素对葡萄胎恶变的早期预测价值

Early prediction value of blood human chorionic gonadotropin level for post-mole gestational trophoblastic neoplasia

目的:探讨葡萄胎恶变的影响因素及动态监测血人绒毛膜促性腺激素(hCG)对葡萄胎恶变的早期预测作用。方法:回顾分析2007年1月-2014年9月在南京医科大学附属南京市妇幼保健院诊治的102例葡萄胎患者的临床资料,其中50例恶变为侵蚀性葡萄胎。通过单变量分析方法分析年龄、生育史、妊娠时间、治疗前血hCG水平、清宫后1d血hCG水平和清宫后1周血hCG水平与葡萄胎恶变的相关性;用ROC曲线分析清宫后1d与清宫后1周的血hCG水平对葡萄胎恶变的预测价值。结果:恶变组与治愈组的年龄、清宫后1d血hCG水平和清宫后1周血hCG水平差异有统计学意义(P<0.05)。清宫后1d血hCG水平预测葡萄胎恶变的ROC曲线下面积为0.60±0.04、敏感度40.4%、特异度77%、预测葡萄胎恶变的阈值为9 300mIU/mL;清宫后1周血hCG水平预测葡萄胎恶变的ROC曲线下面积为0.82±0.03、敏感度71.6%、特异度80.8%、预测葡萄胎恶变的阈值为6 567mIU/mL。结论:年龄、清宫后1dhCG水平和清宫后1周血hCG水平是葡萄胎恶变的相关危险因素,清宫后1周血hCG水平对葡萄胎恶变的预测最有价值。

Objective：To identify the clinical factors associated with hydatidiform mole and to investigate the early prediction effect of dynamic monitoring of blood human chorionic gonadotropin（hCG） for gestational trophoblastic neoplasia （GTN） .Methods：The clinical data of 102 cases of hydatidiform mole diagnosed and treated in Nanjing Maternity and Child Health Care Hospital of Nanjing Medical University were analyzed ,among which 50 cases developed into GTN .The univariate analysis method was used to analyze the correlation between age ,childbearing history ,pregnancy time ,blood hCG levels before treatment ,one day after curettage and one week after curettage with post‐mole GTN .The ROC curve analysis was used to analyze the predictive value of blood hCG levels one day and one week after curettage for post‐mole GTN .Results： The differences in age ,blood hCG levels one day and one week after curettage between the malignant group and the cure group were statistically significant （P〈0 .05） .The area under the curve （AUC） of the blood hCG level one day after curettage predicting GTN was 0 .60 ± 0 .04 ,sensitivity 40 .4% ,specificity 77% ,and the cut‐off point was 9 300 mIU/mL .The AUC of the blood hCG level one week after curettage predicting GTN was 0 .82 ± 0 .03 ,sensitivity 71 .6% ,specificity 80 .8% ,and the cut‐off point was 6 567 mIU/mL .Conclusions：Age ,blood hCG levels one day and one week after curettage were independent risk factors associated with post‐mole GTN . The blood hCG level one week after curettage is the most reliable and strongest predicative factor for post‐mole GTN .