Palmieri Carlo, Dhillon Tony, Fisher Rosemary Ann, Young Anna-Mary, Short Delia, Mitchell Hugh, Aghajanian Carol, Savage Philip Michael, Newlands Edward Stewart, Hancock Barry W, Seckl Michael J
Department of Medical Oncology, Charing Cross Hospital, Fulham Palace Road, London, UK.
Gynecol Oncol. 2007 Jul;106(1):35-43. doi: 10.1016/j.ygyno.2007.01.053. Epub 2007 May 4.
Raised serum beta human chorionic gonadotrophin (beta-hCG) not due to pregnancy can occur as a consequence of (1) gestational trophoblastic neoplasia (GTN), (2) non-gestational trophoblastic tumours, (3) a false-positive beta-hCG, (4) the menopause or (5) a high normal level. Accurate differentiation between these causes is vital to avoid potentially inappropriate investigations and therapies, which may induce infertility or other serious adverse events. Here we report the United Kingdom experience of patients with an elevated beta-hCG of initial uncertain cause and provide a clinical algorithm for the management of such cases.
The Charing Cross and Weston Park Hospital GTN databases were screened to identify patients referred with an elevated beta-hCG who were not pregnant and had no previous diagnosis of GTN.
Between 1981 and 2004 fourteen women presented with persistently raised serum beta-hCG resulting in diagnostic problems. False-positive beta-hCG was excluded in all. Three patients developed gestational choriocarcinoma after 9-29 months. However, in 11 women no cause for the persistently elevated beta-hCG was found. One of these achieved chemotherapy-induced normalisation of serum beta-hCG, but the remaining 10 underwent surgery and/or chemotherapy without benefit. Thus, 71% (10/14) of patients remain well with unexplained elevated beta-hCG levels.
Elevated serum and urinary beta-hCG levels in healthy women should be investigated systematically to exclude an underlying malignant process and to avoid inappropriate surgical and medical intervention. Long-term follow-up is required as tumours may not become apparent for many months or years.
血清β-人绒毛膜促性腺激素（β-hCG）升高并非由妊娠引起，可能是以下原因导致的：（1）妊娠滋养细胞肿瘤（GTN）；（2）非妊娠性滋养细胞肿瘤；（3）β-hCG假阳性；（4）绝经；（5）β-hCG处于正常高水平。准确区分这些原因对于避免可能不适当的检查和治疗至关重要，因为这些检查和治疗可能导致不孕或其他严重不良事件。在此，我们报告英国对初始病因不明的β-hCG升高患者的诊治经验，并提供此类病例的临床处理流程。
筛查了查令十字医院和韦斯顿公园医院的GTN数据库，以确定β-hCG升高且未怀孕且既往未诊断为GTN的转诊患者。
1981年至2004年间，有14名女性出现血清β-hCG持续升高，导致诊断困难。所有患者均排除了β-hCG假阳性。3名患者在9至29个月后发生了妊娠绒癌。然而，在11名女性中，未发现导致β-hCG持续升高的原因。其中1名患者经化疗后血清β-hCG恢复正常，但其余10名患者接受手术和/或化疗均无效果。因此，71%（10/14）的患者β-hCG水平不明原因升高但情况良好。
对于健康女性血清和尿β-hCG水平升高，应进行系统检查以排除潜在的恶性病变，避免不适当的手术和药物干预。由于肿瘤可能在数月或数年之后才会显现，因此需要长期随访。
