持续性真性低水平人绒毛膜促性腺激素升高6例临床特点

  目的  探讨持续性真性低水平人绒毛膜促性腺激素(human chorionic gonadotropin, hCG)升高患者的临床特点和诊治意义。  方法  2011年8月至2015年3月北京协和医院诊断为持续性真性低水平hCG升高患者6例, 收集患者临床资料, 对疾病特点、诊治过程和随诊情况进行回顾性分析。  结果  6例患者中, 3例继发于葡萄胎清宫术后, 3例继发于侵蚀性葡萄胎化疗后。3例侵蚀性葡萄胎患者的中位总疗程数为8个, 均有化疗失败史。6例患者随诊中位时间为24个月, 自治疗结束至hCG呈低水平升高的中位时间为5.5个月, 低水平hCG升高持续的中位时间为16.5个月。4例患者病情稳定, 1例进展为绒毛膜癌, 1例自然妊娠分娩后hCG降至正常。  结论  持续性真性低水平hCG升高的持续时间较长, 对化疗不敏感, 应密切随诊, 不宜治疗。

Clinical Characteristics of Six Patients with Persistent Real Low-level Elevation of Human Chorionic Gonadotropin

  Objective  To investigate the clinical characteristics and significance of diagnosis and treatment associated with persistent real low-level elevation of human chorionic gonadotropin (hCG).  Methods  Six patients diagnosed with persistent real low-level hCG elevation at Peking Union Medical College Hospital in the period from August 2011 to March 2015 were collected. Clinical records of the 6 patients were reviewed to retrospectively analyze clinical features, diagnosis and treatment approaches, and follow-up results.  Results  Among the 6 patients, 3 were secondary to uterine curettage for hydatidiform moles, and the other 3 had received chemotherapy for invasive moles, in whom the median chemotherapy cycle number was 8 and all experienced failure of at least one chemotherapy regimen. The median follow-up time was 24 months. The median period between the termination of treatment and the initial low-level hCG elevation was 5.5 months. The median duration of low-level hCG elevation was 16.5 months. Four patients had no evidence of progression, 1 patient progressed to choriocarcinoma, and 1 presented with the hCG level decreasing to the normal range after spontaneous delivery.  Conclusion  Persistent real low-level hCG elevation may persist for a long time and not respond to chemotherapy. Long-term close monitoring is necessary, but treatment is not recommended.