血液与脑脊液人绒毛膜促性腺激素比值变化在恶性滋养细胞肿瘤脑转移诊治中的意义

Significance of serum/cerebrospinal fluid human chorionic gonadotropin ratio and prophylactic intrathecal therapy in patients with brain metastases of gestational trophoblast tumor

目的 探讨血液与脑脊液中 ,人绒毛膜促性腺激素 (hCG)比值变化在恶性滋养细胞肿瘤脑转移诊治中的意义 ,及预防性鞘内注射甲氨蝶呤 (MTX)的临床价值。方法 对 1986～ 2 0 0 1年 ,北京协和医院收治的 4 4例恶性滋养细胞肿瘤脑转移 (Ⅳ期 )和 2 9例广泛肺转移 (Ⅲ期 )患者的临床资料进行回顾性分析 ,比较血液与脑脊液中hCG比值变化的规律及预防性鞘内注射MTX与脑转移的关系。结果 脑转移患者血液与脑脊液hCG的比值为 2 3～ 799 8,随治疗的进行而逐渐减小至 1,脑疝期和部分脑瘤期患者该比值 <6 0 ,在瘤栓期 >6 0。预防性鞘内注射MTX的Ⅲ期患者未向Ⅳ期发展。结论 化疗前血液与脑脊液hCG比值反映了颅内肿瘤负荷 ,对脑转移临床期别和预后的判断有参考价值。预防性鞘内用MTX对防止脑转移的发生具有积极意义。

Objective To evaluate the effect of serum/cerebrospinal fluid(CSF) ratio of human chorionic gonadotropin(hCG) in detecting brain metastases of gestational trophoblast tumor and the significance of prophylactic intrathecal therapy. Methods Clinical information of 44 patients with brain metastases(stage Ⅳ)and 29 patients with lung metastases (stage Ⅲ) of gestational trophoblast tumor who were admitted to our hospital between 1986 to 2001 were retrospectively analyzed by case control study.The variability of the ratio and the relationship between brain metastases was investigated,together with the effect of prophylactic intrathecal therapy. Results Serum/CSF hCG ratio in patients with brain metastases declined with time.The ratio before chemotherapy was in relevant with the size of the lesion which were less than 60 in advanced stages and more than 60 in early stages.Patients of stage Ⅲ with prophylactic intrathecal therapy did not progress to stage Ⅳ. Conclusions Serum/CSF hCG ratio before chemotherapy could reflect the encephalic tumor load which had reference value in diagnosis and prognosis and prophylactic intrathecal therapy played an important role in preventing brain metastasis.