Ferreira Danyelle Farias, Elito Júnior Julio, Araujo Júnior Edward, Stavale João Norberto, Camano Luiz, Moron Antonio Fernandes
Department of Obstetrics, São Paulo Federal University (UNIFESP), Rua Carlos Weber 956, Apartamento 113 Visage, Alto da Lapa, São Paulo, SP, Brazil.
Department of Pathology, São Paulo Federal University (UNIFESP), São Paulo, SP, Brazil.
Patholog Res Int. 2014;2014:302634. doi: 10.1155/2014/302634. Epub 2014 Jan 9.
Objective. To evaluate trophoblastic cell proliferation and angiogenesis in tubal pregnancy assessed by immunohistochemical study and their correlation with an average variation of β -hCG in an interval of 48 hours before surgery. Methods. A prospective study was conducted on 18 patients with a diagnosis of tubal pregnancy. The patients were divided into two groups of ectopic pregnancy of which 11 showed rise of β -hCG levels and 7 patients showed declining β -hCG levels in an interval of 48 hours prior to surgery. Trophoblastic cell proliferation and angiogenesis were assessed by Ki-67 and VEGF, respectively. Trophoblastic cell proliferation was assessed by Ki-67 and was classified into three groups (grade I: less than 1/3 of stained nuclei, grade II: 1/3 to 2/3 of the stained nuclei, and grade III: more than 2/3 of the nuclei stained). The cases analyzed for VEGF were divided into three groups (grade I: less than 1/3 of the stained cytoplasm; grade II: 1/3 to 2/3 of the stained cytoplasm; grade III: more than 2/3 of the stained cytoplasm). Statistical analysis was performed using the chi-square, ANOVA, and Kruskal-Wallis tests. Results. The mean variation in the serum β -hCG levels in 48 hours in tubal pregnancy patients correlated with trophoblastic cell proliferation assessed by Ki-67 and showed a decline of 13.46% in grade I, a rise of 45.99% in grade II, and ascension of 36.68% in grade III (P = 0.030). The average variation in the serum β -hCG in 48 hours, where angiogenesis was evaluated by VEGF, showed a decline of 18.35% in grade I, a rise of 32.95% in grade II, and ascension of 37.55% in grade III (P = 0.047). Conclusions. Our observations showed a direct correlation of increased levels of serum β -hCG in 48h period prior to surgery with higher trophoblastic cell proliferation assessed by Ki-67 and angiogenesis assessed by VEGF in tubal pregnancy.
目的。通过免疫组织化学研究评估输卵管妊娠中滋养层细胞增殖和血管生成情况，并探讨其与手术前48小时内β -hCG平均变化的相关性。方法。对18例诊断为输卵管妊娠的患者进行前瞻性研究。将患者分为两组异位妊娠患者，其中11例在手术前48小时内β -hCG水平升高，7例患者β -hCG水平下降。分别通过Ki-67和VEGF评估滋养层细胞增殖和血管生成。通过Ki-67评估滋养层细胞增殖并分为三组（I级：染色细胞核少于1/3；II级：染色细胞核为1/3至2/3；III级：染色细胞核超过2/3）。分析VEGF的病例分为三组（I级：染色细胞质少于1/3；II级：染色细胞质为1/3至2/3；III级：染色细胞质超过2/3）。使用卡方检验、方差分析和Kruskal-Wallis检验进行统计分析。结果。输卵管妊娠患者手术前48小时血清β -hCG水平的平均变化与通过Ki-67评估的滋养层细胞增殖相关，I级下降13.46%，II级上升45.99%，III级上升36.68%（P = 0.030）。通过VEGF评估血管生成时，手术前48小时血清β -hCG的平均变化显示，I级下降18.35%，II级上升32.95%，III级上升37.55%（P = 0.047）。结论。我们的观察结果表明，手术前48小时血清β -hCG水平升高与输卵管妊娠中通过Ki-67评估的较高滋养层细胞增殖以及通过VEGF评估的血管生成直接相关。
