B超动态探测妊娠滋养细胞疾病的临床应用价值

目的：探讨B超检查对妊娠滋养细胞疾病的诊断和临床疗效随访的价值。方法：采用B超诊断和动态观察妊娠滋养细胞疾病的进展及黄素囊肿变化68例。结果：葡萄胎42例，有12例在刮宫后10－36天B超探测观察到宫体肌层回声不均，黄素囊肿快速增大的声像图特征。侵蚀性葡萄胎及绒毛膜癌38例（包括葡萄胎恶变12例），28例行单纯化疗，B超动态观察发现随疗程的进展子宫病灶缩小24例。14例行手术治疗，病理检查证实子宫病变12例。术前B超诊断宫体肌层受侵犯符合率85．7％。结论：B超动态探测治疗前后子宫及黄素囊肿的声像图变化，在妊娠滋养细胞疾病诊断和治疗上为临床医生提供了重要的客观的依据。     

75例滋养细胞疾病的超声诊断

B超诊断滋养细胞疾病75例,其中60例为良性,15例为恶性,B超对良性葡萄胎的诊断准确率高达98.33%,对恶性滋养细胞疾病可确定盆腔病灶部位,估计侵润范围,还可用于观察化疗效果,判断疾病预后。结论:B超对滋养细胞疾病的早期诊断,临床分期,疗效观察及预后估计有重要的价值。     

超声诊断在妊娠滋养细胞疾病中的应用

妊娠滋养细胞疾病包括葡萄胎、侵蚀性葡萄胎和绒毛膜癌,后两者称为妊娠滋养细胞肿瘤。葡萄胎组织侵人子宫肌层或转移至子宫以外,即为侵蚀性葡萄胎,绒毛膜癌继发于葡萄胎、流产或足月妊娠分娩以后,是一种高度恶性肿瘤,妊娠滋养细胞疾病的患者大多数为生育年龄妇女,早期诊断与及时化疗是治疗成功的关键。临床诊断主要根据病史、体征、诊断性刮宫与血ＨＣＧ测定来确定。五十年代等［１］报道应用盆腔血管造影技术对滋养细胞肿瘤盆腔病灶进行评估,对确定滋养细胞肿瘤子宫病变的范围及位置有一定价值,但因其创伤性及技术难度使临床应用受…     

葡萄胎恶变相关因素的探讨及瘦素在妊娠滋养细胞疾病中表达的临床意义

目的:研究葡萄胎恶变相关因素的探讨及瘦素(LEP)在妊娠滋养细胞疾病中表达的临床意义。方法:利用免疫组织化学法针对144例葡萄胎、38例侵蚀性葡萄胎、18例绒毛膜癌和50例正常对照绒毛中的LEP表达进行检测,并对出现恶变葡萄胎患者的临床资料进行了统计。结果:LEP在不同类型的妊娠滋养细胞疾病中均得到了表达,滋养细胞的恶性程度与LEP的阳性表达率呈正相关(P0.05);且随着病情恶化程度的加深,其在合体滋养层的阳性表达率越高,差异有统计性意义(P0.05);影响葡萄胎恶变的因素包括患者的发病年龄、子宫大小、卵巢黄素囊肿以及血β人绒毛膜促性腺激素(β-h CG)。结论:影响葡萄胎恶变的因素包括患者的发病年龄、子宫大小以及卵巢黄素囊肿等,LEP在妊娠滋养细胞疾病的阳性表达与疾病的恶性程度呈正相关,对葡萄胎恶变的早期预测产生了积极的影响。     

从临床病理角度对"胎盘植入误诊为绒毛膜癌一例"的讨论

复习原文,其中重点病史及检查结果有几点:①停经50多天,阴道流血8个月;②子宫增大如妊娠3 个月;③血hCG增高;④B超检查子宫增大,宫腔内有包块,右侧宫底及后壁未见正常肌层组织;⑤未刮宫,化疗第1个疗程后阴道排出腐肉样物,随即血hCG及B超基本恢复正常。根据病史及医技检查结果,应该考虑与妊娠有关的疾病或滋养细胞性疾病,这些疾病总是纠缠在一起,现从临床病理角度就本病例的诊断和鉴别诊断谈谈我们的看法。绒癌及侵蚀性葡萄胎:原则上这两种疾病的确诊都是以手术切除的标本为准,因为仅依据阴道排出物及刮宫所取的材料,病理诊断仍有困难,而…     

化学发光法检测β-hCG及临床应用

绒毛膜促性腺激素(hCG)是滋养细胞分泌的一种糖蛋白激素，一旦妊娠产生绒毛即可从血循环中测出。hCG的分泌与滋养细胞的数量密切相关，因此血清hCG测定能在临床上诊断早孕，异位妊娠，先兆流产，葡萄胎及滋养细胞肿瘤，而且在治疗后的随访及预后中成为重要指标。对其他疾病如卵巢生殖细胞，男性睾丸肿瘤，非滋养细胞疾病，非生殖细胞肿瘤也有辅助诊断意义。我院新引进化学发光免疫分析技术(CLIA)对临床血清标本进行β-hCG的定量测定，现对该方法的临床应用评价如下。     

恶性滋养细胞肿瘤的彩色多普勒血流显像特征

目的应用彩色多普勒血流显像（CDFI）分析恶性滋养细胞肿瘤的血供类型特征，探讨CDFI在恶性滋养细胞肿瘤早期诊断及化疗监测中的应用价值。方法分析研究组58例恶性滋养细胞肿瘤的血管形态学CDFI改变，对其峰值血流速度及阻力指数进行了测定，定量测量血B—HCG水平监测化疗反应，对照组36例为葡萄胎清宫术后恢复正常患者。结果恶性滋养细胞肿瘤血流图分为3型：弥漫型、血窦型及实质型。研究组58例获病理诊断18例，包括5例弥漫型及8例血窦型结果为恶性葡萄胎，5例实质型为绒毛膜癌。结论不同类型血流图与血β—HCG、子宫血流动力学改变及化疗的反应相关性好。在基层医院应用CDFI不仅可对恶性滋养细胞肿瘤进行早期诊断，而且可用于观察化疗效果，判断疾病预后转归。     

孕妇血清人绒毛膜促性腺激素水平改变与先兆早产预后的关系

人绒毛膜促性腺激素(hCG)作为胎盘滋养细胞产生的一种糖蛋白激素,临床上一直用于早孕、异位妊娠、滋养细胞疾病的诊断及治疗观察指标.近年来,国内外研究者发现,妊娠中晚期妇女血hCG水平异常改变与不良妊娠结局有关,以其作为预测不良妊娠结局的研究倍受人们重视[1],有学者观察到,妊娠中晚期hCG异常升高的孕妇,发生早产的几率是无此改变者的3～5倍[2],但无hCG水平改变与先兆早产及其预后关系方面的报道.本研究采用放射免疫技术测定了320例28～36周孕妇血消hCG水平,旨在探讨其与先兆早产的关系及预测先兆早产结局的价值.     

化学发光法测定绒毛膜促性腺激素的临床应用评价

目的 :为观察化学发光免疫分析法测定绒毛膜促性腺激素 (hCG)的临床使用价值。方法 :对全自动化学发光免疫分析系统 (automatedchemiluminescencesystem 180 ,简称ACS 180 )测定hCG值与放免法 (RIA)测定 β hCG值进行对照。并对 5 3例滋养细胞疾病血标本进行了化学发光法hCG测定。结果 :以化学发光法测定 β hCG药盒标准品 ,hCG测定值与标准品各浓度点呈显著相关 ,r =0 996 0 ;葡萄胎、绒癌转阴前血标本两法测定值亦存在一定的相关性。结论 :化学发光法测定hCG较RIAβ hCG药盒敏感 ,对葡萄胎、绒癌患者的诊治、随访有重要的临床意义。     

米非司酮药物流产后发生恶性滋养细胞肿瘤四例临床分析

目的 探讨米非司酮药物流产(简称药流)后发生恶性滋养细胞肿瘤的临床特点.方法 对1995年7月至2001年12月米非司酮药流后发生恶性滋养细胞肿瘤4例的临床资料进行回顾性分析.结果 4例恶性滋养细胞肿瘤包括侵蚀性葡萄胎1例、绒癌3例.自米非司酮流产至恶变的潜伏期较短,仅4～6个月,4例药流时未证实为葡萄胎,流产后均有不规则阴道出血.2例并发子宫穿孔,经手术病理证实分别为侵蚀性葡萄胎和绒癌;尿HCG持续阳性,血β-HCG值异常增高,B超检查2例有宫旁低回声包块、1例子宫角部蜂巢状低回声区;X线胸片1例有肺转移.结论 米非司酮药物流产后可发生滋养细胞肿瘤,药物流产前应常规B超检查删除葡萄胎及异位妊娠;流产后如出现阴道异常出血等特殊情况,应动态行血清β-HCG测定及影像检查以明确诊断.     

蛋白电泳扫描积分在肾脏疾病中的临床应用

目的 探讨REP高压快速蛋白电泳扫描积分对肾脏疾病的诊断和鉴别诊断价值。方法 对经临床确诊的178例各类肾脏疾病患者进行REP高压快速蛋白电泳,并对各区带进行扫描,计算各种肾脏疾病的区带扫描积分均值,与正常对照组(20例)比较;同时探讨电泳扫描积分与蛋白质浓度或各区带百分数之间的相关性。结果 电泳扫描积分与蛋白质浓度成正相关(相关系数r＝0．9931);在各种肾脏疾病中,各区带扫描积分均值与对照组比较都有不同程度的增高或降低,尤其是肾病综合征患者,其ALB区带明显减少,α1、α2、β区带显著增加(P值均小于0．01);肾病综合征与其它肾脏疾病相比,其区带积分均值也有明显的差异(P＜0.01);在肾炎和肾功衰患者中,其αl、α2区带的积分均值与对照组比较也有增加趋势(P＜0．05)。在区带的百分数上也有类似的变化。结论 REP高压快速电泳扫描积分对肾脏疾病的诊断和鉴别诊断具有一定的临床价值。     

USA hCG reference service, 10-year report

IntroductionThe USA hCG Reference Service has been dealing with cases of persistent low levels of hCG and gestational trophoblastic diseases for 10 years. Here we present the complete experience.MethodsTotal hCG in serum and urine was measured using the Siemen's Immulite 1000 assay. Hyperglycosylated hCG, nicked hCG, free ß-subunit and ß-core fragment were measured using microtiterplate assays with antibodies B152, B151, FBT11 and B210, respectively.ResultsThe USA hCG Reference Service has identified 83 cases of false-positive hCG, 71 cases of aggressive gestational trophoblastic disease (GTD), 52 cases of minimally invasive GTD, 168 cases of quiescent GTD and 22 cases of placenta site trophoblastic tumor (PSTT). In addition, 103 cases of pituitary hCG have been identified, 60 cases of nontrophoblastic tumor, 4 cases of inherited hCG and 2 cases of Munchausen's syndrome. This is 565 cases total. Multiple new methods are described and tested for diagnosing all of these disorders.ConclusionsThe USA hCG Reference Service experience shows new methods for detecting multiple hCG-related disorders and recommends new approaches for detecting these hCG-related disorders.     

Utility of commonly used commercial human chorionic gonadotropin immunoassays in the diagnosis and management of trophoblastic diseases

BACKGROUND: Patients with trophoblastic diseases produce ordinary and irregular forms of human chorionic gonadotropin (hCG; e.g., nicked hCG, hCG missing the beta-subunit C-terminal segment, hyperglycosylated hCG, and free beta subunit) that are recognized to differing extents by automated immunometric hCG (or hCG beta) assays. This has led to low or false-negative results and misdiagnosis of persistent disease. False-positive hCG immunoreactivity has also been detected, leading to needless therapy for trophoblastic diseases. Here we compare seven commonly used hCG assays. METHODS: Standards for five irregular forms hCG produced in trophoblastic diseases, serum samples from 59 patients with confirmed trophoblastic diseases, and serum samples from 12 women with previous false-positive hCG results (primarily in the Abbott AxSYM assay) were blindly tested by commercial laboratories in the Beckman Access hCG beta, the Abbott AxSYM hCG beta, the Chiron ACS:180 hCG beta, the Baxter Stratus hCG test, the DPC Immulite hCG test, the Serono MAIAclone hCG beta tests, and in the hCG beta RIA. RESULTS: Only the RIA and the DPC appropriately detected the five irregular hCG standards. Only the Beckman, DPC, and Abbott assays gave results similar to the RIA in the patients with confirmed trophoblastic diseases (values within 25% of RIA in 49, 49, and 54 of 59 patients, respectively). For samples that were previously found to produce false-positive hCG results, no false-positive results were detected with the DPC and Chiron tests (5 samples, median <2 IU/L), but up to one-third of samples were false positive (>10 IU/L) in the Beckman (1 of 5), Serono (2 of 9), and Baxter assays (1 of 5), and the hCG beta RIA (3 of 9; median for all assays, <5 IU/L). These samples, which produced false-positive results earlier in the Abbott AxSYM assay, continued to produce high values upon reassessment (median, 81 IU/L). CONCLUSIONS: Of six frequently used hCG immunometric assays, only the DPC detected the five irregular forms of beta hCG, agreed with the RIA, and avoided false-positive results in the samples tested. This assay, and similarly designed assays not tested here, seem appropriate for hCG testing in the diagnosis and management of trophoblastic diseases.     

2型糖尿病患者糖化血红蛋白与血脂水平的研究

目的 研究2型糖尿病（T2DM ）患者糖化血红蛋白（HbA1c）与血脂之间的相关性,并探讨预防和治疗糖尿病并发症的新思路。方法 检测110例T2DM患者和104例体检健康者HbA1c、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白A1（Apo-A1）、载脂蛋白B（Apo-B）的水平;根据HbA1c的水平进行分组,比较不同组间血脂的差异以及HbA1c与血脂的相关性。结果 T2DM 组与健康对照组各项检测结果 比较差异均有统计学意义（P＜0．01）;HbA1c与 TC、TG、LDL-C、Apo-B呈正相关（P＜0．05）,与HDL-C呈负相关（P＜0．05）,与Apo-A1无相关性。结论 HbA1c及血脂水平可作为监测T2DM 患者状况的指标;联合检测HbA1c和血脂对于制订T2DM患者诊疗方案及预防并发症具有重要的临床意义。     

Partial Hydatidiform Mole With False-Negative Urine Human Chorionic Gonadatropin Test in the Emergency Department

Background

Hydatidiform mole (molar pregnancy) is a benign tumor of placental trophoblastic cells, which release human chorionic gonadotropin (hCG). Several case reports have described complete hydatidiform moles with false-negative urine qualitative hCG tests. These negative pregnancy tests have been attributed to the hook effect. We report an unusual presentation of a partial mole and review an alternative explanation for the negative hCG test. As partial moles are usually not associated with a large proliferation of trophoblastic cells, levels of hCG are commonly < 100,000 mIU/mL. The most common presentation of a hydatidiform mole is vaginal bleeding. Hydatidiform mole is associated with a risk of malignant transformation and disseminated disease.

Objective

In a pregnant patient, vaginal bleeding and abdominal pain are common presentations. Molar pregnancy is an uncommon cause of abdominal pain and vaginal bleeding that should be considered.

Case Report

A 47-year-old female presented to the emergency department with abdominal pain and vaginal bleeding. Urine qualitative hCG was negative and serum quantitative hCG was 1,094,950 mIU/mL. Pelvic ultrasonography showed a uterine cavity containing a soft-tissue mass with multiple cystic lesions and the hydatidiform mole was extracted with suction curettage. Tissue pathology confirmed partial hydatidiform mole.

Conclusions

In addition to the hook effect, we present another possible explanation for the false-negative test; namely the inability of some assays to detect hCG-degradation products, which may be higher in clinical samples from patients with hydatidiform mole. This case underscores the importance of knowing the limitations of the commonly used hCG assays.     

剖宫产术后瘢痕部位早期妊娠临床分析

目的探讨剖宫产术后子宫瘢痕妊娠（CSP）的临床特点和治疗方法。方法112例剖宫产术后子宫瘢痕妊娠的患者分为米非司酮组（16例）、氨甲蝶呤（MTX）组（20例）、米非司酮＋MTX组（35例）、子宫动脉栓塞术（UAE）＋MTX组（41例）。观察四组的临床疗效。结果UAE＋MTX组术后血β-人绒毛膜促性腺激素（β—hCG）下降水平、阴道出血时间、月经恢复时间、住院时间均明显低于米非司酮组、MTX组、米非司酮＋MTX组,差异均有统计学意义（P〈0．01）;但住院费用、治疗期间风险明显高于其他三组。治愈率：MTX组为90％,2例患者血13一hCG下降不理想,行B超监测下刮宫术,1周后复查血β-hCG下降,28d降至正常;米非司酮组、米非司酮＋MTX组、UAE-4-MTX组治愈率均为100％。结论剖宫产术后子宫瘢痕妊娠比较少见,临床表现不典型,易发生误诊误治。超声检查是有效的诊断方法。治疗方案应根据患者病情进行个体化综合治疗。     

The need for a quantitative urine hCG assay

BackgroundThe USA uniquely does not use quantitative urine human chorionic gonadotropin (hCG) tests despite being invaluable in pregnancy testing and in monitoring cancer patients. We look at current hCG tests and their detection of the degraded forms of hCG predominant in urine. We examine levels of urinary hCG, its usefulness in pregnancy testing, and advantages of urine testing in false positive hCG cases and cancer cases.MethodshCG assays were blindly evaluated at 10 laboratories running different methodologies. Daily urine samples from 164 women were collected through 5 menstrual cycles or until pregnancy was achieved. Urines were assayed for total hCG. We also examined the use of quantitative urine hCG in confirming false positive serum hCG results in 80 clinical cases.ResultsOnly the Siemens Immulite test was shown to detect the degraded forms of hCG present in urine. This test equally recognized urine and serum hCG. We investigated background hCG in 9026 urines, the mean hCG level was 0.04 IU/L, and the 99th centile was 1.4 IU/L. In cycles where pregnancy was achieved, hCG could be detected in urine at 24.6 days of a 28.7 day menstrual cycle. At this time, the average hCG was 6.02 IU/L, setting a sensitivity level for quantitative urine hCG tests to detect pregnancy. Quantitative urinary hCG proved critical in detecting cancer in 3 of 80 cases complicated by false positive serum hCG.ConclusionsThe need for a quantitative urine hCG assay is undeniable and we invite manufacturers to produce a quantitative urine hCG test.     

Use of serum FSH to identify perimenopausal women with pituitary hCG

BACKGROUND: Human chorionic gonadotropin (hCG) tests are performed on many female patients before performing medical procedures or administering medications that may harm a fetus. hCG of pituitary origin has been shown to increase with age. Therefore, mild increases in serum hCG in an older patient can be of pituitary origin and does not necessarily indicate pregnancy. The inability to rule out pregnancy in perimenopausal women can create clinical confusion and may delay needed therapies. Our objective was to determine the diagnostic utility of serum follicle-stimulating hormone (FSH) concentrations to rule out hCG of placental origin in perimenopausal women with a low concentration of serum hCG (5.0-14.0 IU/L). METHODS: Seven testing centers performed 39 742 physician-ordered serum quantitative hCG tests over a 15-month period. From these, 100 samples from women 41-55 years of age with serum hCG concentrations 5-14 IU/L were identified. We performed FSH testing and patient chart review for each sample. RESULTS: Twenty-three patients were found to have hCG of placental origin (pregnancy, resolving abortion, or gestational trophoblastic disease), and in those cases serum FSH was 0.4-43.8 IU/L. An FSH cutoff of 45.0 IU/L identified hCG of placental origin with 100% sensitivity and 75% specificity. FSH >45 IU/L was never observed when hCG was of placental origin (negative predictive value). CONCLUSIONS: These data indicate that quantitative serum FSH can be used to rule out pregnancy and hCG of placental origin in women 41-55 years of age with mild increase in serum hCG concentrations.     

Detection of hepatitis B virus DNA sequences in liver in HBsAg seronegative patients with liver disease with and without anti-HBc antibodies

Excluding studies from Brechot and co-workers, little support has been found for a role of the hepatitis B virus in the pathogenesis of HBsAg seronegative patients with predominantly chronic liver diseases, including primary liver cancer. In this study liver DNA from 59 predominantly British patients (four cases with paired biopsies, 6-12 months apart) with different, mostly chronic, liver diseases was analysed by molecular hybridization. All were seronegative for HBsAg and serum hepatitis B virus DNA (dot blot hybridization) and their liver diseases were believed to be unrelated to hepatitis B virus infection. Hepatitis B virus DNA was detected in liver of 11 (18.6 per cent) patients; nine had episomal (3.2 Kb) DNA and eight had higher molecular weight bands suggesting integrated forms. Six patients were also seronegative for anti-HBc. Patients of UK and non-UK origin were equally represented. Hepatitis B virus DNA was detected in serum of six of nine patients tested using the polymerase chain reaction. The detection of hepatitis B virus DNA in liver and in serum by this assay in a significant proportion of patients with chronic liver disease, hitherto unsuspected of being hepatitis B virus-related, suggests a possible role for this virus in low- as well as high-prevalence countries.