输卵管壶腹部妊娠患者血清VEGF及β-HCG水平与滋养细胞浸润输卵管壁深度的相关性研究

Correlation of serum VEGF and β-HCG levels with the depth of trophoblast cells invasion into the fallopian tube wall in patients with ampullary pregnancy

目的探讨输卵管壶腹部妊娠患者血清VEGF及β-HCG水平与滋养细胞浸润输卵管壁深度的相关性。方法对94例输卵管壶腹部妊娠患者的血清VEGF及β-HCG水平进行检测,同时对术中获取的组织学标本进行镜检,确定滋养细胞浸润输卵管壁深度分级。采用ROC曲线计算Ⅰ/Ⅱ级和Ⅱ/Ⅲ级的临界值,及其灵敏度、特异度、阳性预测值和阴性预测值。结果 94例患者滋养细胞浸润输卵管壁深度包括Ⅰ级34例,Ⅱ级37例,Ⅲ级23例;血清VEGF与β-HCG水平随浸润级别升高均同步升高,各级两两比较差异均有统计学意义(P<0.001);血清VEGF水平以309.4 pg/m L为临界值,诊断Ⅰ级与Ⅱ级的灵敏度为100%,特异度为93.5%,以429.8 pg/m L为临界值,诊断Ⅱ级与Ⅲ级的灵敏度为79.5%,特异度为84.3%;血清β-HCG水平以2497.5m IU/m L为临界值,诊断Ⅰ级与Ⅱ级的灵敏度为91.4%,特异度为81.8%,以13187.2 m IU/m L为临界值,诊断Ⅱ级与Ⅲ级的灵敏度为72.3%,特异度为79.4%。结论输卵管壶腹部妊娠患者血清VEGF及β-HCG水平越高提示滋养细胞浸润输卵管壁深度越深。

Objective To investigate the correlation of serum o VEGF and β-HCG levels with the depth of trophoblast cells invasion into the fallopian tube wall in patients with ampullary pregnancy. Methods Serum levels of VEGF andβ-HCG were measured in 94 cases of ampullary pregnancy. Microscopic examination of surgical specimen was performed to determine the depth of trophoblast cells invasion in the fallopian tube wall. The critical values of Ⅰ/Ⅱ and Ⅱ/Ⅲ levels were calculated by using ROC curves,and their sensitivity,specificity,positive predictive value and negative predictive value were calculated. Results Pathological examination of trophoblast cells invasion revealed 34 cases of grade I,37 cases of grade Ⅱ,and 23 cases of grade Ⅲ. Serum VEGF and β-HCG levels were significantly increased in association with the degree of invasion; all levels were statistically significant（P〈0. 001）. Using 309. 4 pg/m L as the critical value for the serum level of VEGF,the sensitivity of diagnosis of grade Ⅰ and Ⅱ was 100%,the specificity was 93. 5%; with 429. 8 pg/m L as the critical value,the sensitivity of diagnosis of grade Ⅰ and Ⅱ was 79. 5%,the specificity was 84. 3%. Using 2497. 5 m IU/m L as the critical value for the serum level of β-HCG,the sensitivity of diagnosis of grade Ⅰ and Ⅱ 91. 4%,the specificity was 81. 8%; with 13187. 2 m IU/m L as the critical value,the sensitivity of diagnosis of grade Ⅰ and Ⅱ was 72. 3%,the specificity was 79. 4%. Conclusion The higher levels of serum VEGF and β-HCG in patients with ampullary pregnancy,the deeper trophoblast cells invasion in the uterine tube wall.