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.

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.

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“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。

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。

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。

河北省免费NIPT联合PAPP-A、F-β-HCG 及超声检查诊断孕中期胎儿染色体异常的意义

目的 评价河北行免费的无创产前DNA检测(NIPT),联合血清妊娠相关血浆蛋白-A(PAPP-A)、游离β-人绒毛膜促性腺激素(F-β-HCG)检测及超声对孕中期染色体异常的诊断价值。方法 选取衡水市第二人民医院2019年1月至2023年1月接收的3 591例拟行染色体检测的孕中期妇女,均行免费NIPT联合血清学指标(PAPP-A、F-β-HCG)及超声检查。将羊水穿刺染色体核型分析结果记为金标准,采用受试者工作特征曲线(ROC)评价不同方法诊断孕中期染色体异常的价值。结果 经随访,在3 591例中,共有39例染色体异常,其中,32例经超声检查有染色体异常,34例经NIPT检测有染色体异常。在3 552例染色体正常的胎儿中,34例经超声检查有染色体异常,36例经NIPT检测有染色体异常;染色体异常胎儿的母体PAPP-A、F-β-HCG水平均高于染色体正常胎儿的母体(P<0.05)。PAPP-A、F-β-HCG共同诊断胎儿染色体异常的敏感度及ROC曲线下方的面积(AUC)均高于母体PAPP-A、F-β-HCG单独诊断(P<0.05);NIPT,PAPP-A、F-β-HCG及超声的联合诊断的敏感度及AUC均高于NIPT,PAPP-A、F-β-HCG,超声的单独诊断(P<0.05),且不同方法诊断染色体异常的特异度对比差异均无统计学意义(P>0.05)。结论 孕中期胎儿染色体异常的母体PAPP-A、F-β-HCG水平高,且NIPT联合PAPP-A、F-β-HCG及超声诊断染色体异常有较好的价值。

荧光免疫法和2种化学发光法检测血清总β-HCG结果的比对分析

目的:通过比较同一实验室3种不同方法学(荧光免疫法(星童Pylon3D)、电化学发光法(罗氏e601)和酶促化学发光法(迈瑞CL-6000i))测定血清总β-HCG的结果,探讨3种方法检测β-HCG的结果是否具有可比性,为不同仪器测定实验结果互认提供依据。方法:选取不同浓度常规血清标本186份,先在罗氏e601电化学发光系统进行检测,再用星童Pylon3D荧光免疫法和迈瑞CL-6000i酶促化学发光法检测系统进行检测。以罗氏e601电化学发光检测系统作为参考仪器进行数据比对。结果:3种方法学之间检测结果的相关性都在0.99以上,相关性良好。随着β-HCG浓度范围的增高,3种方法学检测结果的相关性,都呈现出越来越高的趋势。总体一致性分析,迈瑞的数值与罗氏较为靠近,偏倚均数Bias=-528.3mIU/mL,P<0.05,是最低的,另外两组的偏倚均数都在-1000mIU/mL以上。结论:3种检测系统对总β-HCG检测结果之间具有良好的相关性和一致性。

人绒毛膜促性腺激素激发试验在性发育异常儿童中的诊断作用评估

目的探讨人绒毛膜促性腺激素(human chorionic gonadotrophin,hCG)激发试验在诊断不同分型性发育异常(disorder of sexual development,DSD)患儿中的价值。方法回顾性分析132例DSD患儿,按染色体核型分为46,XX组(n=10)、46,XY组(n=87)、性染色体异常组(n=35),比较各组患儿hCG激发试验前后的性激素水平,分析形态学上是否存在睾丸组织对hCG激发试验结果的影响。结果3组患儿激发试验后睾酮(testosterone,T)增加倍数比较差异无统计学意义(P>0.05)。46,XY组中,5α-还原酶2缺乏症患儿激发试验后的T与双氢睾酮(dihydrotestosterone,DHT)比值高于其他46,XY DSD患儿(P<0.05)。形态学上,有睾丸组织的DSD患儿激发试验后T增加倍数高于无睾丸组织患儿(P<0.05)。结论hCG激发试验对于评估不同类型的DSD患儿的睾丸间质细胞存在和功能均具有重要价值,对于性腺性质不明确的DSD患儿,均建议行hCG激发试验。

西藏地区宫外孕患者经腹彩色超声联合血清β-hCG、ALP、CA125的诊断价值探讨

目的检测β-人绒毛促性腺激素(β-hCG)、碱性磷酸酶(ALP)、癌胚抗原125(CA125)在宫外孕(EP)患者血清中表达水平,探讨经腹彩色超声联合β-hCG、ALP、CA125对EP的诊断价值。方法选取2023年6月—2024年4月西藏自治区人民医院妇产科门诊就诊的EP患者79例作为病例组,另选正常宫内妊娠孕早期女性82例作为对照组。测定2组受试者血清β-hCG、ALP、CA125水平,腹部彩色超声检查子宫内膜厚度、盆腔积液;采用Pearson相关分析病例组血清β-hCG、ALP、CA125与腹部彩色超声参数相关性;多因素Logistic回归分析EP发生的影响因素;受试者工作特征(ROC)曲线分析经腹彩色超声联合血清β-hCG、ALP、CA125对EP的诊断价值。结果病例组β-hCG、ALP低于对照组(t=21.390、19.690,P<0.001),CA125高于对照组(t=33.390,P均<0.001);与对照组比较,病例组子宫内膜厚度变薄(t=14.440,P<0.001);子宫内膜厚度与血清β-hCG、ALP呈正相关,与CA125水平呈负相关(r=0.685、0.632、-0.701,P均<0.001);多因素Logistic回归分析,子宫内膜增厚、血清β-hCG高以及ALP高水平是宫外孕发生的保护因素[OR(95%CI)=0.937(0.896~0.972)、0.873(0.804~0.948)、0.077(0.034~0.097)],血清CA125高水平、盆腔积液增多是宫外孕发生的危险因素[OR(95%CI)=1.232(1.161~1.307)、2.955(1.887~4.626)];子宫内膜厚度、盆腔积液、β-hCG、ALP、CA125及5项联合预测EP的AUC分别为0.843、0.802、0.942、0.843、0.916、0.988,5项联合优于各自单独预测效能(Z/P=2.370/0.018、2.147/0.032、2.001/0.039、1.990/0.046、2.676/0.007)。结论EP患者子宫内膜变薄、盆腔积液增多、血清β-hCG水平低、ALP水平低、CA125水平高,腹部彩色超声联合血清β-hCG、ALP、CA125水平检测可提高EP的诊断效能。

经阴道三维彩超联合血β-人绒毛膜促性腺激素对早期宫外孕的诊断价值

目的探讨经阴道三维彩超联合血β-人绒毛膜促性腺激素(β-hCG)对早期宫外孕的诊断价值。方法选取2020年8月至2023年9月安庆市第一人民医院收治的80例早期宫外孕患者作为研究对象,设为观察组。另选取同期80例宫内孕孕妇设为对照组。分析两组超声指标与血β-hCG水平;绘制超声指标、血β-hCG单独及联合诊断早期宫外孕的受试者工作特征(ROC)曲线;通过病理结果分析经阴道三维彩超联合血β-hCG诊断的准确性。结果两组阻力指数、搏动指数、收缩期峰值流速比较,差异无统计学意义(P>0.05);观察组子宫内膜厚度、血β-hCG水平均小于对照组,差异具有统计学意义(P<0.05)。ROC曲线结果显示,子宫内膜厚度、血β-HCG及两者联合诊断宫外孕的曲线下面积分别为0.833、0.877及0.975(P<0.05)。与病理结果比较,经阴道三维彩超联合血β-hCG诊断漏诊、误诊5例,诊断准确率为93.75%。结论经阴道三维彩超联合血β-hCG对早期宫外孕具有较高的诊断价值,可为临床快速准确诊断早期宫外孕提供可靠信息。

β-人绒毛膜促性腺激素快速高灵敏化学发光POC检测方法的建立及评价

目的:建立β-人绒毛膜促性腺激素(β-HCG)快速高灵敏化学发光POC检测法(POC-CLIA)并进行评价。方法:采用碱性磷酸酶(Alp)-AMPPD发光体系,以磁微粒(Mps)为固相载体构建POC-CLIA,并评估其灵敏度、精密度、准确度、线性范围、特异性、稳定性、钩状效应和临床应用。结果:β-HCG最低检测限为0.71 mU/ml,线性检测范围为0.710~1.092×10^(4) mU/ml,且在1.7×10^(5) mU/ml内无钩状效应影响。批内和批间变异系数均<10%,可在37℃稳定保存10 d。准确度偏差在±10%之内,结果可靠。干扰物质与β-HCG均无交叉反应。对100例临床血清标本进行检测,与临床标准方法检测结果高度相关(R^(2)=0.997 0)。单个样品检测时间<15 min,且测试通量可达到200 T/h。结论:该方法具有较高应用价值,可广泛用于基层社区,助力基层医疗中妊娠及相关疾病筛查。

腹腔镜下单侧输卵管切除术对输卵管妊娠患者血清β-hCG、Netrin-1及术后妊娠影响

目的:探讨腹腔镜下单侧输卵管切除术对输卵管妊娠患者血清β-人绒毛膜促性腺激素(β-hCG)、神经轴突导向因子-1(Netrin-1)水平及对术后妊娠的影响。方法:选取2021年1月-2022年11月本院行腹腔镜下单侧输卵管切除术患者40例(观察组)、腹腔镜下单侧输卵管开窗取胚术患者40例(对照组),统计手术相关指标、并发症,手术前后血清β-hCG、Netrin-1水平以及术后卵巢储备功能指标,随访术后1年内妊娠情况。结果:观察组术中出血量(72.1±4.8ml)多于对照组(66.1±12.4ml),术后并发症发生率(7.5%)和术后继续异位妊娠率(0)低于对照组(25.0%、17.5%);术后6个月,血清促黄体激素(6.15±1.12mU/ml)高于对照组(5.63±0.95mU/ml),抗缪勒管激素(3.33±0.58ng/ml)低于对照组(3.64±0.79ng/ml)(均P<0.05)。两组术后第3dβ-hCG、Netrin-1水平及术后β-hCG、Netrin-1降低至正常水平时间也无差异(均P>0.05)。结论:腹腔镜下单侧输卵管切除术、输卵管开窗取胚术均能有效清除异位着床组织,但腹腔镜下单侧输卵管切除术术后并发症和再次异位妊娠风险更低,但存在术中出血量多、损伤卵巢储备功能风险。

输卵管妊娠药物治疗前血中人绒毛膜促性腺激素变化趋势对疗效的预测作用

【目的】探讨治疗前血中人绒毛膜促性腺激素(β-HCG)变化趋势对输卵管妊娠药物治疗疗效的预测作用。【方法】收集从2017年1月至2022年6月广州中医药大学第一附属医院收治的接受药物治疗的380例输卵管妊娠患者的临床资料,根据治疗方案的不同,分为纯中药治疗组(简称纯中药组)271例和中西医结合治疗组(简称中西医结合组)109例,对可能影响不同治疗方案治疗结局的相关因素进行分析,使用Logistic回归分析控制混杂因素,分析治疗前血β-HCG的变化趋势对不同治疗方案治疗结局的影响;使用受试者工作特征(ROC)曲线评估治疗前血β-HCG变化值对疗效的预测价值。【结果】(1)单因素分析结果显示:纯中药组和中西医结合组的治疗前2次检测的血β-HCG初始值、β-HCG变化趋势和变化值均与治疗结局有关,差异均有统计学意义(P<0.05或P<0.01)。(2)多因素回归分析结果显示:在纯中药组中,治疗前2次检测的血β-HCG值、β-HCG变化趋势与治疗结局存在相关性,差异均有统计学意义(P<0.05或P<0.01);在中西医结合组中,停经时间、治疗前第2次检测的血β-HCG值与治疗结局存在相关性,差异均有统计学意义(P<0.05)。(3)控制混杂因素后,纯中药组治疗前β-HCG变化趋势与治疗结局相关,差异有统计学意义(OR=3.35,95%CI为1.69-6.65,P=0.001);而中西医结合组的β-HCG变化趋势则不影响治疗结局,差异无统计学意义(P>0.05)。(4)通过受试者工作特征(ROC)曲线分析,纯中药组ROC曲线下面积(AUC)为0.74,cutoff值为-0.14,其敏感度为71.3%,特异度为67.8%。中西医结合组AUC为0.67,cutoff值为0.10,其敏感度为73.6%,特异度为60.7%。【结论】治疗前血β-HCG变化趋势可以有效预测中药治疗输卵管妊娠的疗效,而不具有预测中西医结合治疗输卵管妊娠疗效的价值;治疗前血β-HCG变化值可以作为早期预测输卵管妊娠药物治疗结局的有价值的参考值。