Uterine epithelioid trophoblastic tumor with the main manifestation of increased human chorionic gonadotropin:A case report

BACKGROUND Epithelioid trophoblastic tumor(ETT)is an extremely rare malignant gestational trophoblastic neoplasm commonly presenting with abnormal vaginal bleeding,abdominal pain,and increased human chorionic gonadotropin(hCG).This study reported a case of uterine ETT with the main manifestation being increased hCG.CASE SUMMARY A 39-year-old female was referred to the Ningbo Maternal and Child Hospital of China in December 2022,complaining of increased hCG levels for 1 month.Magnetic resonance imaging revealed gestational trophoblastic tumor,and hysteroscopic electrotomy and curettage of intrauterine hyperplasia were performed.The patient was diagnosed with uterine ETT through postoperative pathological examination and immunohistochemical results.Total laparoscopic hysterectomy and bilateral salpingectomy were performed,and hCG levels returned to normal.The patient was without recurrence during the postoperative 3-month follow-up.CONCLUSION This study reported a case of uterine ETT with the main manifestation being increased hCG,highlighting that ETT should be considered in the presence of abnormal hCG.A total laparoscopic hysterectomy is recommended.

The Study on Immuno-response and Antisera Properties of Recombinant β-subunit of Human Chorionic Gonadotropin in C57 Black Mouse

In this study, the immuno-response of recombinant hCG-β and natural hCGβ was comparatively investigated by using Freund's adjuvant. The results showed that, the properties and merits of the antibodies elicited by both kinds of hCG-β were similar. The antisera had high affinity for binding with hCG (Kαγβ≈5.86×108/mol/L, Kαβ≈8.18×108/mol/L), and were found to be effective in inhibiting the binding of 125I-hCG to receptors in rat testes. Results also indicated that, similar to the antisera induced by natural hCG-β, the recombinant hCG-β induced antisera had capacity of neutralizing the biological activities of hCG. Recombinant hCG-β could be used as an immunogen for contraceptive vaccine.

Predictive Value of Initial Serum Human Chorionic Gonadotropin Levels for Pregnancies after Single Fresh and Frozen Blastocyst Transfer

As one of the earliest markers for predicting pregnancy outcomes, human chorionic gonadotropin(h CG) values have been inconclusive on reliability of the prediction after frozen and fresh embryo transfer(ET). In this retrospective study, patients with positive h CG(day 12 after transfer) were included to examine the h CG levels and their predictive value for pregnancy outcomes following 214 fresh and 1513 vitrified-warmed single-blastocyst transfer cycles. For patients who got clinical pregnancy, the mean initial h CG value was significantly higher after frozen cycles than fresh cycles, and the similar result was demonstrated for patients with live births(LB). The difference in h CG value existed even after adjusting for the potential covariates. The area under curves(AUC) and threshold values calculated by receiver operator characteristic curves were 0.944 and 213.05 m IU/m L for clinical pregnancy after fresh ET, 0.894 and 399.50 m IU/m L for clinical pregnancy after frozen ET, 0.812 and 222.86 m IU/m L for LB after fresh ET, and 0.808 and 410.80 m IU/mL for LB after frozen ET with acceptable sensitivity and specificity, respectively. In conclusion, single frozen blastocyst transfer leads to higher initial h CG values than single fresh blastocyst transfer, and the initial h CG level is a reliable predictive factor for predicting IVF outcomes.

Second-trimester maternal β-human chorionic gonadotropin level associated with subsequent development of pregnancy-induced hypertension

Objective:To determine whether maternal β-human chorionic gonadotropin(β-hCG) level in second-trimester may be associated with subsequent development of pregnancy-induced hypertension(PIH).Methods:Seven hundred and sixty-two women in mid-trimester were to have maternal urine β-hCG standardized concentrations and maternal serum β-hCG measurements.Their case histories were recorded and reviewed from mid-trimester to delivery.The relation was observed between maternal urine,serum markers and subsequent development of PIH.Results:Among 762 women,504 cases were normal pregnancies,42 cases had PIH,94 cases had premature rupture of membrane (PROM),69 cases had preterm delivery (PD),53 other cases were excluded by various reasons.The levels of maternal urine,serum β-hCG in PIH were (61.75±9.78) IU/L and (304.56±54.17) ng/mg respectively,which were higher significantly than normal pregnancy group ([20.65±7.61] IU/L and [146.34±47.81] ng/mg,P<0.05).When maternal serum,urine β-hCG levels ≥2 MOM(multiple of mean),the incidences of developing PIH were increased significantly as compared with those of β-hCG <2 MOM women.The incidence of PIH increased from 5.1% in pregnancies with urine β-hCG ≥2 MOM to 11.7% in cases with urine β-hCG ≥4 MOM.Conclusion:The elevation of maternal mid-trimester urine,serum β-hCG levels is not only an early signal for dysfunction of placenta but also a dangerous signal for development of PIH.Second-trimester maternal urine β-hCG measurement proves to be superior to serum marker in clinical prediction.

How and Why Do Gestational Trophoblastic Neoplasms Overproduce Human Chorionic Gonadotropin?

From the published data, the present mini-review attempts to answer two fundamental questions about the gestational trophoblastic neoplasms. In addition, it extrapolates the findings to other cancers that produce small amounts of hCG and how a novel therapies could be developed.

Expression of Beta-Human Chorionic Gonadotropin Genes in Renal Cell Cancer and Benign Renal Disease Tissues

To study the expression of beta-human chorionic gonadotropin (βhCG) genes in renal cell carcinomas (RCC) and benign renal disease tissues, nested reverse transcription-polymerase chain reaction (RT-PCR) and restriction endonuclease analysis were employed to detect the expression of βhCG genes in 44 cases of RCC tissues and 24 cases of benign renal disease tissues It was found that 52% RCC samples revealed positive for βhCG mRNA expression Positive rate in advanced stage and poorly differentiated RCC was higher, but there was no significant difference The positive rate of βhCG mRNA expression was 54% in 24 cases of benign renal tissues, including 3 cases out of 6 polycystic kidneys, 7 cases out of 13 renal atrophies, 2 cases out of 2 oncocytomas and 1 case out of 2 pyonephrotic kidneys β7 was most frequently transcribed subtype gene independent on the histology These findings suggested βhCG gene transcription is not only involved in RCC but also in benign renal diseases

Effects on Cell Viability and on Apoptosis in Tumoral(MCF-7)and in Normal(MCF10A)Epithelial Breast Cells after Human Chorionic Gonadotropin and Derivated-Angiotensin Peptides Treatments

Angiotensin-(1 - 7) [Ang-(1 - 7)] is an endogenous heptapeptide hormone of the renin-angiotensin system that has antiproliferative properties. The aim of this work was to evaluate the anti-proliferative and pro-apoptotic properties of Ang-(1 - 7) and of Ang-(1 - 7)-substituents 9-fluorenylmethyloxycarbonyl (Fmoc) e Ang II-derivatives containing the TOAC (2,2,6,6-tetramethylpiperidine-N-oxyl-4-amino-4-carboxylic acid) in normal (MCF10A) and in tumoral (MCF7) epithelial mammary cell lines. Both cell lines received an hCG and angiotensin peptides 24-hour treatment, in combination or alone followed by cell viability, apoptosis and cell cycle assays performed by flow cytometer (GUAVA). After hCG, Ang-(1 - 7), hCG + Ang-(1 - 7) and hCG + Ang-(1 - 7)-Fmoc treatments, MCF7 displayed cell viability decrease and mid-apoptosis increase. We also observed cell viability decrease in MCF10A after Ang-(1 - 7), Ang-(1 - 7) Fmoc and hCG + AngII Toac treatments. These cells had an increase in late apoptosis and necrosis after AngII Toac, hCG + Ang-(1 - 7) and hCG + Ang-(1 - 7)-Fmoc treatments. Regarding the cell cycle analysis, we did not observed any changes in cell cycle phases. In summary, cell viability was decreased and apoptosis (initial, mid and late) was increased after hCG and/or Ang-(1 - 7) peptides treatments. These results point out hCG and Ang-(1 - 7) as effective compounds to inhibit cell proliferation, since they decrease cell viability and increase apoptosis in both normal and in tumoral breast cells, being the effect more pronounced in the tumoral cell line. Our results support the idea of investigating more closely the putative use of these compounds as novel therapeutic agents for breast cancer.

Effect of different fertilization time after human chorionic gonadotropin injection on fertilization outcome of patients in vitro fertilizationembryo transfer

Objective:To explore the effect of different fertilization time after human chorionic gonadotropin(HCG)injection on the outcome of fertilization in vitro fertilization-embryo transfer(IVF-ET).Methods:One thousand one hundred and forty IVF-ET cycles from January 2016 to August 2018 were analyzed retrospectively.According to the different fertilization time after injection of HCG divided into four groups:Group A(38.0 h~39.0 h),Group B(39.1 h~40.0 h),Group C(40.1 h~41.0 h),and Group D(41.1 h~42.0 h).The normal fertilization rate,the normal cleavage rate,the embryo utilization rate,the high-quality embryo rate,the clinical pregnancy rate,the implantation rate,and the spontaneous abortion rate were analyzed among the groups.Then we investigated the effect of different promotion methods on the outcome of fertilization during the optimal fertilization time.Results:There was no significant difference in 2PN cleavage rate,available embryo rate,clinical pregnancy rate,implantation rate and abortion rate among the four groups(P>0.05).The high-quality embryo rate in Group D(44.6%)was the highest,and was significantly different among the four groups(P<0.05).The normal fertilization rate in Group D(71.6%)was the highest,and was significantly different among the four groups(P<0.05).The normal fertilization rate(78.1%)of antagonist group was significantly higher than other groups(P<0.05).Conclusion:The different fertilization time after HCG injection have effects on high-quality embryo rate and normal fertilization rate of patients in IVF-ET.The appropriate fertilization time of patients in IVF-ET was 41 h~42 h after HCG injection in our reproductive center,improved the clinical pregnancy rate and reduced the early abortion rate.The GnRH-ant protocol is superior to other protocol in IVF-ET.

Effect of TCDD on Maternal Toxicity and Chorionic Gonadotropin──Bioactivity in the Immediate Post-implantation Period of Macaque

The purpose of this experiment was to observe the alterations in bioactivity of chorionic gonadotropin (CG) associated with early fetal loss (EFL), induced by the environmental toxin TCDD (2,3,7,8\|tetrachlorodibenzo\| p \|dioxin) in the cynomolgus macaque. Ten of twelve females administered single doses of 1, 2 or 4 μg/kg TCDD on gestational day (GD) 12 had EFL from ten to twenty days later. Seven control animals treated only with the vehicle had normal pregnancies. Blood samples were repeatedly collected for hormone evaluation, from two days before treatment to thirty\|one days following treatment. Immunoreactive monkey chorionic gonadotropin (mCG) was measured in serum using ELISA, and bioactive mCG was measured using a luminescence LH/CG bioassay. No change in immunoreactive mCG levels was detected as a result of TCDD, treatment, but bioactive mCG levels were significantly lower in TCDD\|treated animals compared to controls. This change in bioactivity of mCG was also reflected in the ratio of mCG bioactivity to mCG immunoreactivity (B/I ratio) which began to rise in normal pregnancies by GD 20, but did not rise in TCDD treated animals. These results demonstrate that normal pregnancy in the monkey, as in humans, is characterized by a post\|implantation change in the B/I ratio of CG. These findings therefore suggest that changes in the production of bioactive CG may be used as a biomarker of environmental toxicant exposures which lead to EFL.

响应面法优化人绒毛膜促性腺激素(hCG)中间体提取工艺

人绒毛膜促性腺激素(hCG)中间体是重要的医药原料,为优化hCG中间体提取工艺,提高hCG提取效率,本研究以hCG粗品为原料,使用乙酸钠缓冲液一步浸提法从hCG粗品中提取hCG中间体,先以单因素实验研究了缓冲液浓度、液料比、搅拌时间和搅拌温度对hCG中间体提取效价的影响,在此基础上通过响应面实验优化了提取工艺。结果表明:影响hCG中间体效价的因素从大到小排序为液料比、搅拌时间、缓冲液浓度、搅拌温度,液料比和缓冲液浓度两因素之间的交互作用对hCG中间体效价有显著影响,以此建立提取hCG中间体效价多元回归数学模型。优化后的提取hCG中间体工艺最佳条件为乙酸钠缓冲液浓度为0.15 mol/L、液料比(mL/g)为11∶1、搅拌时间为2 h、搅拌温度为10℃,在此条件下,提取后hCG中间体效价为259.55 IU/mg。该工艺较传统工艺参数明确,步骤简单,减少了原辅材料使用,提取用时减少了50%,hCG中间体效价提高了29.78%,应用前景广阔。

辅助生殖技术中双扳机应用的研究进展

在辅助生殖技术(assisted reproductive technology,ART)的控制性超促排卵(controlled ovarian hyperstimulation,COH)过程中,适当扳机方式的选择至关重要。随着对人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)扳机及促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonist,GnRH-a)扳机利弊研究的不断深入,双扳机即GnRH-a联合hCG扳机被提出并应用于临床,以期减少卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)发生率,改善ART结局。然而,由于不同患者在年龄、卵巢储备、体质量指数(body mass index,BMI)等方面存在异质性,双扳机应用于卵巢高反应、正常反应及低反应人群可能产生不同程度的效果。综述双扳机的最新研究进展,以期为临床不同卵巢反应患者扳机方式的选择提供参考,并探讨了双扳机需要继续深入研究的方向,如扳机药物剂量、取卵时机、个体化黄体支持方案及新扳机方式的探索。

Evaluation of pig oocyte in vitro maturation and fertilization using three gonadotropin-based hormonal compounds

Objective:To evaluate the effect of human chorionic gonadotropins(hCG)and equine chorionic gonadotropins(eCG)on in vitro gilt oocyte maturation and embryonic development,using frozen semen for fertilization.Methods:Two independent experiments(6 replicates each)were carried out to evaluate gilt oocyte maturation,and fertilization and embryonic development by using ovaries from a local abattoir.Totally,712 oocytes were randomly distributed in four-well dishes to receive Novormon(eCG 5.0 IU),PG600(eCG 5.0 IU and hCG 2.5 IU),Chorulon(hCG 5.0 IU),or no hormones.Oocytes were incubated with 5%CO2,95%air and saturation humidity at 39℃for 44 h.Maturation of the oocytes to metaphaseⅡwas assessed by using the aceto-orcein technique.In addition,741 oocytes were used and randomly distributed in four-well dishes,and then oocyte maturation was carried out as mentioned,but matured oocytes were washed and placed in fertilization medium with frozen-thawed sperm.Gametes were co-incubated for 7 h,and then washed and placed in development medium,and incubated for further 7 days,at which time embryonic development was evaluated.Fertilization and embryo development media were not supplemented with the studied hormones.Results:Novormon(eCG)and PG600(eCG+hCG)treatments significantly improved the percentages of metaphaseⅡoocytes compared to the control group(P<0.05).Furthermore,a significant increase was also observed in the young blastocyst stage between the control group and the PG600 treatment group(P<0.05).Conclusions:Hormonal products Novormon(eCG)and PG600(eCG+hCG)can obtain the highest percentages of in vitro maturation in gilt oocytes;however,this effect is not transferred to fertilization rates.

Live births from in vitro fertilization-embryo transfer following the administration of gonadotropin-releasing hormone agonist without gonadotropins:Two case reports

BACKGROUND The prevalence of female infertility between the ages of 25 and 44 is 3.5%to 16.7%in developed countries and 6.9%to 9.3%in developing countries.This means that infertility affects one in six couples and is recognized by the World Health Organization as the fifth most serious global disability.The International Committee for Monitoring Assisted Reproductive Technology reported that the global total of babies born as a result of assisted reproductive technology procedures and other advanced fertility treatments is more than 8 million.Advancements in controlled ovarian hyperstimulation procedures led to crucial accomplishments in human fertility treatments.The European Society for Human Reproduction and Embryology guideline on ovarian stimulation gave us valuable evidence-based recommendations to optimize ovarian stimulation in assisted reproductive technology.Conventional ovarian stimulation protocols for in vitro fertilization(IVF)–embryo transfer are based upon the administration of gonadotropins combined with gonadotropin-releasing hormone(GnRH)analogues,either GnRH agonists(GnRHa)or antagonists.The development of ovarian cysts requires the combination of GnRHa and gonadotropins for controlled ovarian hyperstimulation.However,in rare cases patients may develop an ovarian hyper response after administration of GnRHa alone.CASE SUMMARY Here,two case studies were conducted.In the first case,a 33-year-old female diagnosed with polycystic ovary syndrome presented for her first IVF cycle at our reproductive center.Fourteen days after triptorelin acetate was administrated(day 18 of her menstrual cycle),bilateral ovaries presented polycystic manifestations.The patient was given 5000 IU of human chorionic gonadotropin.Twenty-two oocytes were obtained,and eight embryos formed.Two blastospheres were transferred in the frozen-thawed embryo transfer cycle,and the patient was impregnated.In the second case,a 37-year-old woman presented to the reproductive center for her first donor IVF cycle.Fourteen days after GnRHa administration,the transvaginal ultrasound revealed six follicles measuring 17-26 mm in the bilateral ovaries.The patient was given 10000 IU of human chorionic gonadotropin.Three oocytes were obtained,and three embryos formed.Two high-grade embryos were transferred in the frozen-thawed embryo transfer cycle,and the patient was impregnated.CONCLUSION These two special cases provide valuable knowledge through our experience.We hypothesize that oocyte retrieval can be an alternative to cycle cancellation in these conditions.Considering the high progesterone level in most cases of this situation,we advocate freezing embryos after oocyte retrieval rather than fresh embryo transfer.

宫腔灌注HCG联合地屈孕酮对复发性流产患者外周血淋巴细胞水平和妊娠结局的影响

目的:了解宫腔灌注人绒毛膜促性腺激素(HCG)联合地屈孕酮对复发性流产(RSA)患者的外周血淋巴细胞水平变化和妊娠结局的影响。方法:选取2019年1月~2020年10月深圳市宝安区妇幼保健院就诊的RSA患者43例作为研究对象,分为研究组(n=19)与对照组(n=24),对照组给予地屈孕酮,研究组在对照组基础上给予宫腔灌注HCG,分析两组治疗前后着床期外周血淋巴细胞、雌二醇(E2)、孕酮(P)及3个周期的临床妊娠结局。结果:两组患者在年龄、不良孕产次数以及排卵日子宫内膜厚度上比较差异无统计学意义(P>0.05);治疗前两组在着床期E_(2)及P比较差异无统计学意义(P>0.05),治疗后研究组与对照组的血清E_(2)、P均较治疗前升高,且治疗后的研究组的E_(2)及P较对照组升高,差异均有统计学意义(P<0.05);治疗前及治疗后两组在着床期外周血B淋巴细胞、NK细胞、CD3^(+)T细胞、CD3^(+)CD8^(+)T细胞以及CD4^(+)/CD8^(+)T细胞比较差异均无统计学意义(P>0.05),但研究组外周血CD3^(+)CD4^(+)T细胞百分比较治疗前升高,差异均有统计学意义(P<0.05);研究组的临床妊娠率高于对照组,孕早期自然流产率低于对照组,两组比较差异均有统计学意义(P<0.05)。结论:宫腔灌注HCG联合地屈孕酮治疗RSA可以通过提升着床期的雌、孕激素值以及增加外周血淋巴细胞中的CD3^(+)CD4^(+)T细胞百分比提升RSA患者临床妊娠率及降低流产的风险。

超声NT及LC联合母血分子标志物评估高危妊娠产妇妊娠结局的价值

目的:探讨超声颈项透明层厚度(NT)、子宫颈长度(LC)联合游离人绒毛膜促性腺激素(B-HCG)、妊娠相关血浆蛋白(PAPPA)、D二聚体(D-D)评估高危妊娠产妇妊娠结局的价值。方法:回顾性选取2019年1月至2022年1月在我院就诊的高危妊娠产妇80例作为研究对象,根据是否发生不良妊娠结局分为有不良妊娠结局组和无不良妊娠结局组,比较两组NT、LC、动脉S/D、PI、RI以及血清B-HCG、PAPPA、D-D的差异,以及指标间的相关性和对不良妊娠结局的预测价值。结果:有不良妊娠结局产妇的B-HCG、PAPPA、D-D和NT分别为(2.28±0.62)mom、(0.72±0.16)mom、(351.12±82.80)mg/L和(3.78±0.81)mm,明显高于无不良妊娠结局产妇(1.75±0.41)mom、(0.57±0.15)mom、(295.33±85.52)mg/L和(3.31±0.64)mm(P<0.01),而LC为(24.49±4.53)mm,明显低于无不良妊娠结局产妇(31.01±5.12)mm(P<0.01)。B-HCG、PAPPA、D-D水平与NT呈正相关(P<0.05),而与LC呈负相关(P<0.05)。NT、LC联合B-HCG、PAPPA、D-D预测高危妊娠产妇不良妊娠结局的ROC曲线下面积为0.911(95CI:0.848~0.974),明显高于各指标单独预测,其灵敏性和特异性分别为79.20%和96.30%,P<0.01。结论:NT、LC及B-HCG、PAPPA、D-D与高危妊娠产妇不良妊娠结局有相关性,在预测高危妊娠产妇不良妊娠结局中有较好的价值。

产前超声定量参数联合血清β-人绒毛膜促性腺激素、甲胎蛋白、游离雌三醇对胎儿颜面部畸形筛查具有较好价值

目的探讨产前超声定量联合血清β-人绒毛膜促性腺激素(β-HCG)、甲胎蛋白(AFP)、游离雌三醇(uE3)对胎儿颜面部畸形的筛查价值。方法选取2021年2月~2024年2月在我院进行产前筛查的123例孕中期孕妇为研究对象,均接受超声检查与血清指标检测,以引产或妊娠结果为“金标准”,分析产前超声定量参数、血清指标对胎儿颜面部畸形的诊断价值。结果123例孕妇最终发现胎儿颜面部畸形71例(57.72%),52例胎儿未出现颜面部畸形(42.28%)。单因素及多因素Logistic回归分析结果显示颈项透明层厚度(NT)、β-HCG、AFP及uE3水平均是胎儿颜面部畸形的危险因素(P<0.05)。超声NT诊出胎儿颜面部畸形61例,血清指标诊出胎儿颜面部畸形56例,联合检测诊出胎儿颜面部畸形67例,超声NT联合血清指标检测对胎儿颜面部畸形的诊断敏感度、特异度及准确度均高于单一检测,组间敏感度差异有统计学意义(P<0.05),但两组特异度、准确度的差异无统计学意义(P>0.05)。结论NT、β-HCG、AFP及uE3水平异常均提示胎儿颜面部畸形发生的高风险性。产期超声定量参数联合血清β-hCG、AFP、uE3可明显提高对胎儿颜面部畸形的检出敏感度,对产前颜面部畸形筛查有着较好的临床应用价值。

化学发光法超高值样本自动稀释检测的质量风险分析与防控策略

目的探讨化学发光法检测系统中超高值样本自动稀释检测的质量风险,并提出相应的防控策略,以期为临床实验室的质量改进提供科学依据。方法本研究以1例β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-hCG)超高值样本化学发光法检测结果假性降低为例,通过事件调查、结果分析和实验验证等方法,分析导致检测结果假性降低的原因,识别出超高值样本自动稀释检测的质量风险,并提出相应的防控策略。结果经调查,检测系统更换新批号试剂后,共有34份超高值样本的β-hCG检测结果出现假性降低,与试剂校准生成的工作曲线异常有关。重新校准后,超高值样本复测结果显著升高(t=6.465,P<0.001),与临床反馈相符,且校准后未自动稀释时复测结果的相对发光单位(RLUs)值与第一次检测时的RLUs值差异无统计学意义(t=0.577,P=0.566),验证了原工作曲线异常是导致检测结果假性降低的主要原因。此外,在室内质控在控、试剂间新鲜患者样本比对通过的情况下,仍发生了该不良事件,表明临床实验室现有质量控制程序在监测超高值样本检测稳定性方面存在不足。结论临床实验室应加强对超高值样本自动稀释检测的质量控制,通过优化校准流程、自制超高值质控品、加强仪器间和试剂批号间比对等措施,提高检测结果的准确性和可靠性,降低患者安全风险。

超声“四切面”法联合妊娠中期产妇血清Freeβ-hCG和uE3筛查胎儿严重先天性心脏病的研究

目的:探究超声“四切面”法联合妊娠中期孕妇血清游离人绒毛膜促性腺激素(Freeβ-hCG)和雌三醇(uE3)筛查胎儿严重先天性心脏病(CHD)的临床应用价值。方法:选择2020年1月到2021年6月我院行妊娠中期CHD筛查的孕妇97例,检测孕妇血清Freeβ-hCG和uE3水平,采用超声“四切面”法筛查CHD,分析超声“四切面”法联合血清Freeβ-hCG和uE3水平对CHD的诊断价值。结果:97例孕妇随访确诊为严重CHD 9例(9/97,9.28%);超声“四切面”法检查提示高危胎儿25例,其中4例确诊为严重CHD(4/25,16.00%);孕妇血清学检测提示高危胎儿36例,其中6例最终确诊为严重CHD(6/36,16.67%);超声“四切面”法联合孕妇血清学检测提示高危胎儿9例,其中5例确诊为严重CHD(5/9,55.56%)。超声“四切面”法筛查严重CHD的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为16.00%、93.51%、74.51%、44.44%和77.22%。孕妇血清Freeβ-hCG和uE3水平筛查严重CHD的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为55.56%、95.31%、92.08%、66.67%和64.00%,二者联合筛查严重CHD的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为55.56%、95.65%、92.08%、55.56%和91.09%。二者联合检测的诊断情况高于单一检测方法(P<0.05)。结论:超声“四切面”法对妊娠中期孕妇筛查严重CHD具有较高的诊断价值,联合孕妇血清Freeβ-hCG和uE3水平能进一步提高诊断准确度,具有较好的临床应用价值。

孕中期胎盘功能监测指标的临床研究

目的探讨孕中期胎盘功能监测指标的临床效果。方法选取2021年1月至2023年12月南昌市第一医院诊断为胎儿生长受限(FGR)的60例孕妇设为观察组,正常孕妇60例设为对照组,比较两组胎盘血流学参数[血管指数(VI)、血流指数(FI)和血管血流综合指数(VFI)]、胎盘形态学参数[胎盘体积(PV)]以及外周血胎盘激素[人绒毛膜促性腺激素(hCG)、游离雌三醇(uE3)]等指标差异,分析绘制受试者工作特征(ROC)曲线,分析VI、VFI、FI、PV、hCG、uE3预测FGR价值。结果观察组VI为(15.47±2.39)、VFI为(4.14±0.72)、FI为(21.21±2.31)、PV为(35.51±3.42)cm3,均低于对照组,差异有统计学意义(P<0.05);观察组hCG检测值高于对照组,而uE3检测值低于对照组,差异有统计学意义(P<0.05);VI、VFI、FI、PV、hCG、uE3联合检测预测FGR的曲线下面积(AUC)为0.923,灵敏度为0.917,特异度为0.837,均高于单一检测。结论孕中期胎盘功能监测指标与FGR发生关系密切,各指标联合检测可有效预测FGR发生。

血清指标联合经阴道腹部超声对早期异位妊娠的诊断价值

目的分析血清β-人绒毛膜促性腺激素(β-HCG)、癌抗原199(CA199)、孕酮(P)水平检测联合经阴道、腹部超声对早期异位妊娠的诊断价值。方法选取2020年10月至2023年10月烟台市烟台山医院收治的93例拟诊早期异位妊娠患者作为研究对象,其中经术后病理确诊为早期异位妊娠患者82例(观察组),年龄(31.35±3.16)岁;另选取同期正常宫内妊娠产妇105例作为对照组,年龄(31.57±3.22)岁。回顾性收集研究对象的临床资料,分析两组研究对象的血清β-HCG、CA199、P水平,经阴道、经腹部超声声像表现及早期异位妊娠的诊断结果。统计比较采用t检验、χ^(2)检验,绘制受试者操作特征曲线(ROC)。结果观察组血清β-HCG、CA199、P水平均低于对照组(均P<0.05)。93例初诊早期异位妊娠患者均进行病理学检查,82例为阳性;经阴道超声检查:72例真实早期异位妊娠;经腹部超声检查:69例真实早期异位妊娠。经腹部超声检查中子宫直肠窝积液、原始心管搏动、附件区包块、宫内未见孕囊的患者占比均低于经阴道超声(均P<0.05)。绘制ROC,经阴道超声、经腹部超声、血清β-HCG、CA199、P水平单独及联合检测的曲线下面积(AUC)分别为0.716、0.657、0.630、0.605、0.691、0.910,灵敏度为65.85%、63.41%、70.73%、58.54%、68.29%、86.59%,特异度为72.73%、72.73%、63.64%、72.68%、63.64%、81.82%。结论早期异位妊娠患者中血清β-HCG、CA199、P水平及经阴道、经腹部超声检测均存在异常表达情况,联合检测对早期异位妊娠患者具有较高的诊断价值,可作为早期异位妊娠临床诊治的靶点。