血HCG检测在阴道分娩后宫内妊娠残留物清宫术中的价值

【摘要】 目的 探讨血绒毛膜促性腺激素（HCG）检测在阴道分娩后宫内妊娠残留物(RPOCs)清宫术中的价值。方法 采用回顾性研究方法,将阴道分娩后1cm＜RPOCs＜3cm的产妇100例根据是否发生晚期产后出血分为清宫组(观察组）与非清宫组（对照组）,每组各50例,用化学发光法检测患者血中HCG,用B超检查两组产妇RPOCs大小,对比两组产妇血HCG水平及RPOCs大小差异。结果 出院前观察组产时出血、产后出血、产后3天出血、出院前血红蛋白（HGB）与对照组相比,差异无统计学意义(P＞005)。出院后产褥期内血情况比较,观察组阴道出血量较对照组多、阴道出血时间较对照组长、最低HGB较对照组低,差异有统计学意义( P＜001)。观察组血HCG为（305235±135856）mIU/ml 对照组为（99270±24546）mIU/ml,观察组血HCG明显高于对照组,差异有统计学意义( P＜001)。观察组92%（46/50）患者血HCG水平＞200000mIU/ml。观察组RPOCs大小与对照组（200±048cm vs 203±045 cm）相比,观察组RPOCs较对照组小,但差异无统计学意义(P＞0．05)。两组患者近期并发症比较,观察组血象与对照组血象发生分别为4800%和 2600%、发热发生率3400%和1400%、败血症发生率1600%和200%、贫血发生率6000%和2200%、重度贫血发生率2200%和000%均较对照组高,产后42天子宫完全复旧发生率分别为8400%和10000%差异有统计学意义( P＜001)。结论 阴道分娩后1cm＜RPOCs＜3cm产妇发生晚期产后出血主要与血HCG有关,与RPOCs大小关系不确切,对于血HCG＜200000mIU/ml产妇出院前不需常规清宫,而血HCG＞200000mIU/ml产妇出院前予以清宫,可减少阴道分娩后因RPOCs过度清宫或清宫不及时所带来并发症。     

Expression of human chorionic gonadotropin, CD44v6 and CD44v4/5 in esophageal squamous cell carcinoma

AIM: To study the relationship between the expression of human chorionic gonadotropin (HCG), CD44v6, CD44v4/5 and the infiltration, metastasis of esophageal squamous cell carcinoma. METHODS: By labeled streptavidin-biotin technique, the expressions of HCG, CD44v6, and CD44v4/5 in 42 patients with esophageal squamous cell carcinoma were examined. RESULTS: The positive rate of HCG expression in patients with lymph node metastasis was 85.71% (18/21), higher than that (57.14%, 12/21) in those without lymph node metastasis (P<0.05). The positive rate of CD44v6 expression was 71.43% (15/21) in lymph node metastasis group, and 38.09% (8/21) in non-metastasis group; there was a significant difference between the two groups (P<0.05). The positive rate of CD44v4/5 expression was 76.19% (16/21) in lymph node metastasis group, and 42.86% (9/21) in non-metastasis group; there was also a significant difference between them (P<0.05). From grade Ⅰ to grade Ⅲ in differentiation, the positive rate of HCG expression was 84.62% (11/13), 70.59% (12/17) and 58.33% (7/12), respectively; there was no significant difference among them (P<0.05). The positive rate of CD44v6 expression in grades Ⅰ-Ⅲ of cancer tissues was 76.92% (10/13), 52.94% (9/17), and 33.33% (4/12) respectively; there was no significant difference among them. The positive rate of CD44v4/5 expression in grades Ⅰ-Ⅲ of cancer tissues was 69.23% (9/13), 64.71% (11/17), and 41.67% (5/12) respectively; there was no significant difference among the three groups. There was no correlation between the positive rates of HCG and CD44v6, CD44v4/5 expression. Cancer cells in carcinomatous emboli and those infiltrating into vascular wall strongly expressed HCG, CD44v6, and CD44v4/5. CONCLUSION: Expression of HCG, CD44v6, and CD44v4/5 in esophageal squamous cell carcinoma is related to its infiltration and metastasis. HCG, CD44v6, and CD44v4/5 have different effects on the infiltration and metastasis of esophageal squamous cell carcinoma.     

促排卵在排卵障碍性不孕患者自然受孕的应用观察

目的探讨HMG/E2/HCG/HPFSH/P方案在排卵功能障碍性不孕患者自然受孕周期中的应用。方法对98例患者随机分为观察组63例,对照组35例,观察组用HMG/E2/HCG/HPFSH/P治疗,对照组用CC/HCG治疗。结果两组比较,观察组的受孕率为68.25%,对照组的受孕率为34.29%,观察组受孕率明显高于对照组。结论通过HMG/E2/HCG/HPFSH/P治疗,自然受孕率有明显提高。     

EMAb、血清β-HCG及黄体酮联合预测早孕先兆流产结局

目的 探讨抗子宫内膜抗体(EMAb)、人绒毛膜促性腺激素(β-HCG)、黄体酮联合检查预测早孕先兆流产结局的价值.方法 将早孕先兆流产120例病例根据保胎治疗后的妊娠结局分为两组,即保胎成功组78例、保胎失败组42例,分别检测治疗前后两组血清中EMAb,β-HCG及黄体酮的含量,以评价早孕先兆流产的预后.结果 检测两组患者血清中EMAb阳性率,保胎成功组为7.69%,保胎失败组为38.10%,保胎成功组中EMAb阳性率低(P<0.05);检测两组患者血清中β-HCG及黄体酮水平,在治疗前后保胎成功组均较保胎失败组高(P<0.05);两组患者经保胎治疗后血清β-HCG均较治疗前升高(P<0.05),而黄体酮无明显变化.结论 EMAb、β-HCG、黄体酮联合检查可更准确预测先兆流产结局,为临床诊疗提供理论依据.     

Is continuation of a gonadotrophin-releasing hormone agonist (GnRHa) necessary for women at risk of developing the ovarian hyperstimulation syndrome?

A total of 28 women scheduled for in-vitro fertilization used buserelin and human menopausal gonadotrophin (HMG) for ovarian stimulation. One group (I) of 17 women was given human chorionic gonadotrophin (HCG 10,000 IU) to trigger ovulation, but the resulting embryos were electively cryopreserved because of the risk (serum oestradiol greater than or equal to 3500 pg/ml) of developing the ovarian hyperstimulation syndrome (OHSS). Six women continued the buserelin therapy in the luteal phase and eleven did not. In group II (n = 11), the HMG injections were discontinued because of an exaggerated ovarian response and the HCG was omitted. Six of these women continued the buserelin injections until the onset of menses and five did not. In both groups, the ovarian response to induction of ovulation (serum oestradiol concentrations and number of follicles) was similar for those who did or did not continue buserelin therapy. There was no difference in the rate of ovarian quiescence (weekly fall in serum oestradiol concentration following the stimulation) between those women who did or did not continue the buserelin therapy in either group. The serum luteinizing hormone concentrations remained low in all women in both groups. We conclude that the omission of buserelin therapy after discontinuing the HMG in women at risk of developing OHSS does not affect subsequent ovarian quiescence.     

Placental protein 14 in human in-vitro fertilization early pregnancies.

Placental protein 14 (PP14) and human chorionic gonadotrophin (HCG) were analysed in patients participating in an in-vitro fertilization-embryo transfer programme which did not include any kind of luteal support. Women with normal pregnancies, spontaneous abortions, ectopic pregnancies, biochemical pregnancies and non-pregnant women were compared. A combination of HCG and PP14 analyses distinguished between normal and abnormal implantation as early as 15 days after oocyte retrieval. The product of HCG (IU/l) and PP14 (micrograms/l) concentrations differed significantly between normal pregnancy, spontaneous abortion and ectopic pregnancy (P = 0.0248). It is concluded that both endometrial (PP14) and trophoblastic (HCG) markers, when used in combination, exhibit changes in abnormal implantation which may be clinically useful.     

Successful treatment with methotrexate of five vital interstitial pregnancies.

Five patients with vital, unruptured interstitial pregnancies of less than 3 cm maximum diameter were treated successfully with methotrexate and leucovorin rescue. Four pregnancies showed cardiac activity. Diagnosis was established with transvaginal ultrasonography in all patients. The human chorionic gonadotrophin serum levels were measured to monitor the effectiveness of therapy. This is the first publication on methotrexate treatment for interstitial twin pregnancy and the first on instillation of methotrexate after puncture and aspiration of interstitial pregnancy. In all cases, total and uneventful regression of trophoblast tissue was achieved. No adverse reactions were observed. The advantages and drawbacks of these therapeutic approaches are discussed. Methotrexate appears to be an effective medical non-surgical treatment for unruptured interstitial pregnancy with or without cardiac activity, and preserves reproductive potential.     

Maternal serum markers in screening for Down syndrome

The addition of two new markers in maternal serum, estriol and HCG, to those already known, namely the level of maternal serum alfa-fetoprotein and maternal age, considerably improves the expected results of a screening strategy for Down syndrome. The detection rate is slightly increased from 53.0% to 57.6%, but, more importantly, the false-positive rate decreases from 9.4% to 7.3%. It is our belief that, at least in women aged less than 35 years, a screening strategy based on a combination of maternal age and biochemical markers should be incorporated into antenatal care. For older women, the results of such a maternal serum test may refine counseling for genetic amniocentesis, as a much more explicit risk calculation can be performed than that based on age alone.     

葡萄胎68例临床分析

目的:对葡萄胎的发病诱因、临床表现进行分析并探讨正确的处理措施,避免转化为侵蚀性葡萄胎。方法:回顾性分析2001年3月~2004年3月68例葡萄胎患者的临床资料。结果:经过治疗性吸宫术43例,预防性化疗18例,子宫切除7例,化疗等治疗无一例死亡,随访2年~4年均健在,HCG测定正常,临床治愈率为100%。结论:对葡萄胎早诊断、早治疗、密切随访,高危病例宜行预防性化疗及宫切非常重要。