Porto Alegre Trophoblastic Disease Center, Mario Totta Maternity Ward, Hospital Irmandade da Santa Casa de Misericórdia, Porto Alegre, RS, Brazil.
Rio de Janeiro Gestational Trophoblastic Disease Reference Center, Department of Obstetrics and Gynecology, Maternity School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Rev Bras Ginecol Obstet. 2020 May;42(5):240-247. doi: 10.1055/s-0040-1710302. Epub 2020 May 29.
To compare the effect of high-dose vitamin A (HD Vit-A) use during postmolar follow-up of patients with low and plateauing (L&P) serum human chorionic gonadotropin (hCG) levels, from the moment serum hCG plateaued (P-hCG) to the first normal serum hCG value (< 5 IU/L).
The present retrospective series case study compared two nonconcurrent cohorts of patients. Control group (CG): 34 patients with L&P serum hCG levels who underwent expectant management for 6 months after uterine evacuation, from 1992 to 2010; study group (SG): 32 patients in similar conditions who received 200,000 IU of Vit-A daily, from the identification of a P-hCG level to the first normal hCG value or the diagnosis of progression to gestational trophoblastic neoplasia (GTN), from 2011 to 2017. The present study was approved by the Ethics Committee of the institution where it was conducted.
In both groups, the prevalence of persistent L&P serum hCG levels was < 5%. In the SG, hCG levels at plateau were higher (CG = 85.5 versus SG = 195 IU/L; = 0.028), the rate of postmolar GTN was lower (CG = 29.4% versus SG = 6.3%, = 0.034) and follow-up was shorter (CG = 14 versus SG = 10 months, < 0.001). During GTN follow-up, there were no differences in GTN staging or treatment aggressiveness in both groups. High-dose Vit-A use did not have any relevant toxic effect. There were no GTN relapses or deaths.
The limited use of HD Vit-A seems to have a safe and significant effect on the treatment of postmolar patients with L&P serum hCG levels and may decrease the development of postmolar GTN in this population.
比较高剂量维生素 A（HD Vit-A）在低水平和平台化（L&P）血清人绒毛膜促性腺激素（hCG）水平的患者在血清 hCG 平台化（P-hCG）至首次正常血清 hCG 值（<5IU/L）期间的后续治疗中的作用。
本回顾性系列病例研究比较了两组非同期患者。对照组（CG）：1992 年至 2010 年间，34 例 L&P 血清 hCG 水平患者在子宫排空后接受期待治疗 6 个月；研究组（SG）：32 例处于类似条件下的患者，从 P-hCG 水平确定开始每日接受 20 万 IU 的 Vit-A，直至首次正常 hCG 值或诊断为妊娠滋养细胞肿瘤进展（GTN），时间范围为 2011 年至 2017 年。本研究得到了开展研究的机构伦理委员会的批准。
两组患者持续性 L&P 血清 hCG 水平的发生率均<5%。SG 组 hCG 平台期水平更高（CG=85.5 与 SG=195IU/L；=0.028），摩尔后 GTN 的发生率更低（CG=29.4%与 SG=6.3%，=0.034），随访时间更短（CG=14 与 SG=10 个月，<0.001）。在 GTN 随访期间，两组的 GTN 分期或治疗强度均无差异。高剂量 Vit-A 治疗没有产生任何相关的毒性作用。没有 GTN 复发或死亡。
有限使用 HD Vit-A 似乎对治疗 L&P 血清 hCG 水平的摩尔后患者具有安全且显著的效果，可能降低该人群中摩尔后 GTN 的发生。
