血清β-人绒毛膜促性腺激素水平与输卵管妊娠中肌层输卵管浸润及存活滋养层细胞团的相关性

Association of serum beta-hCG levels with myosalpingeal invasion and viable trophoblast mass in tubal pregnancy.

作者信息

Oktay K, Brzyski R G, Miller E B, Krugman D

机构信息

Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington.

出版信息

Obstet Gynecol. 1994 Nov;84(5):803-6.

PMID:7524002

Abstract

OBJECTIVE

To test the hypothesis that myosalpingeal invasion and viable trophoblast mass are associated with serum beta-hCG levels in tubal-ampullary pregnancy.

METHODS

Twenty-seven salpingectomy specimens of tubal-ampullary pregnancies were assessed for the presence or absence of myosalpingeal invasion. The mass of viable trophoblast was quantified in terms of the number of high-power fields (x400) occupied. The cases were stratified into three groups: small, less than one field; medium, one or two fields; and large, more than two fields and/or embryo present. Beta-hCG was measured before the procedure (mIU/mL, Third International Standard).

RESULTS

The mean (+/- standard error of the mean) beta-hCG level for the nine cases exhibiting myosalpingeal invasion was significantly higher than for the 18 cases without invasion (13,665 +/- 2986 versus 2169 +/- 870 mIU/mL; P = .0001). Beta-hCG levels greater than or equal to 5400 mIU/mL predicted myosalpingeal invasion in eight of nine cases (positive predictive value 89%). In contrast, levels less than 5400 mIU/mL were associated with lack of myosalpingeal invasion in 17 of 18 cases (negative predictive value 94%). The volume of trophoblast mass correlated with both beta-hCG levels (r = 0.647, P = .0003) and myosalpingeal invasion (r = 0.735, P = .0001). There was no invasion in the 13 cases in the group with small trophoblast mass, whereas two of five cases in the medium-mass group displayed myosalpingeal invasion. In this group, the mean beta-hCG for cases with myosalpingeal invasion was higher than in the cases without invasion (16,917 +/- 117 versus 3799 +/- 1094 mIU/mL; P = .003). In the group with large trophoblast mass, seven of nine specimens showed myosalpingeal invasion.

CONCLUSION

Both myosalpingeal invasion and viable trophoblast mass correlate positively with serum levels of beta-hCG. Myosalpingeal invasion is highly likely when beta-hCG levels reach 5400 mIU/mL.

摘要

目的

检验输卵管壶腹部妊娠中肌输卵管浸润和存活滋养层细胞团与血清β-人绒毛膜促性腺激素（β-hCG）水平相关的假设。

方法

对27例输卵管壶腹部妊娠的输卵管切除术标本评估有无肌输卵管浸润。根据高倍视野（×400）的占据数量对存活滋养层细胞团进行定量。病例分为三组：小，少于一个视野；中，一个或两个视野；大，多于两个视野和/或有胚胎。术前测量β-hCG（mIU/mL，第三国际标准）。

结果

9例出现肌输卵管浸润的病例的平均（±平均标准误）β-hCG水平显著高于18例未出现浸润的病例（13,665±2986对2169±870 mIU/mL；P = 0.0001）。β-hCG水平大于或等于5400 mIU/mL在9例中的8例中预测了肌输卵管浸润（阳性预测值89%）。相比之下，18例中的17例β-hCG水平低于5400 mIU/mL与无肌输卵管浸润相关（阴性预测值94%）。滋养层细胞团体积与β-hCG水平（r = 0.647，P = 0.0003）和肌输卵管浸润（r = 0.735，P = 0.0001）均相关。滋养层细胞团小的组中的13例无浸润，而中等细胞团组的5例中有2例出现肌输卵管浸润。在该组中，出现肌输卵管浸润的病例的平均β-hCG高于未出现浸润的病例（16,917±117对3799±1094 mIU/mL；P = 0.003）。在滋养层细胞团大的组中，9个标本中有7个显示肌输卵管浸润。