Abide Yayla Cigdem, Özkaya Enis, Yenidede Ilter, Eser Ahmet, Ergen Evrim Bostancı, Tayyar Ahter Tanay, Şentürk Mehmet Baki, Karateke Ates
a Department of Obstetrics and Gynaecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , Istanbul , Turkey.
J Matern Fetal Neonatal Med. 2018 Feb;31(3):271-277. doi: 10.1080/14767058.2017.1281906. Epub 2017 Feb 2.
The aim of this study was to discriminate mole pregnancies and invasive forms among cases with first trimester vaginal bleeding by the utilization of some complete blood count parameters conjunct to sonographic findings and beta human chorionic gonadotropin concentration.
Consecutive 257 cases with histopathologically confirmed mole pregnancies and 199 women without mole pregnancy presented with first trimester vaginal bleeding who admitted to Zeynep Kamil Women and Children's Health Training Hospital between January 2012 and January 2016 were included in this cross-sectional study. The serum beta HCG level at presentation, and beta hCG levels at 1st, 2nd and 3rd weeks of postevacuation with some parameters of complete blood count were utilized to discriminate cases with molar pregnancy and cases with invasive mole among first trimester pregnants presented with vaginal bleeding and abnormal sonographic findings.
Levels of beta hCG at baseline (AUC = 0.700, p < 0.05) and 1st (AUC = 0.704, p < 0.05), 2nd (AUC = 0.870, p < 0.001) and 3rd (AUC = 0.916, p < 0.001) weeks of postevacuation period were significant predictors for the cases with persistent disease. While area under curve for mean platelet volume is 0.715, it means that mean platelet volume has 21.5% additional diagnostic value for predicting persistency in molar patients. For 8.55 cut-off point for mean platelet volume, sensitivity is 84.6% and specificity is 51.6%. Area under curve for platelet/lymphocyte ratio is 0.683 means that platelet/lymphocyte ratio has additional 18.3% diagnostic value. For 102.25 cut-off point sensitivity is 86.6% and specificity is 46.2.
Simple, widely available complete blood count parameters may be used as an adjunct to other risk factors to diagnose molar pregnancies and predict postevacuation trophoblastic disease.
本研究的目的是通过结合一些全血细胞计数参数、超声检查结果和β-人绒毛膜促性腺激素浓度，来鉴别孕早期阴道出血病例中的葡萄胎妊娠和侵袭性病变。
本横断面研究纳入了2012年1月至2016年1月期间在泽伊内普·卡米尔妇女儿童医院就诊的257例经组织病理学确诊为葡萄胎妊娠的病例，以及199例无葡萄胎妊娠但有孕早期阴道出血的妇女。利用就诊时的血清β-HCG水平、清宫后第1、2和3周的β-HCG水平以及一些全血细胞计数参数，来鉴别有阴道出血和超声检查异常的孕早期孕妇中的葡萄胎妊娠病例和侵袭性葡萄胎病例。
基线时（AUC = 0.700，p < 0.05）以及清宫后第1周（AUC = 0.704，p < 0.05）、第2周（AUC = 0.870，p < 0.001）和第3周（AUC = 0.916，p < 0.001）的β-HCG水平是持续性疾病病例的显著预测指标。平均血小板体积的曲线下面积为0.715，这意味着平均血小板体积在预测葡萄胎患者的持续性方面具有额外21.5%的诊断价值。对于平均血小板体积8.55的截断点，敏感性为84.6%，特异性为51.6%。血小板/淋巴细胞比值的曲线下面积为0.683，这意味着血小板/淋巴细胞比值具有额外18.3%的诊断价值。对于102.25的截断点，敏感性为86.6%，特异性为46.2。
简单且广泛可用的全血细胞计数参数可作为其他风险因素的辅助手段，用于诊断葡萄胎妊娠并预测清宫后滋养细胞疾病。
