Clinical Characteristics of Six Patients with Persistent Real Low-level Elevation of Human Chorionic Gonadotropin
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摘要:
目的 探讨持续性真性低水平人绒毛膜促性腺激素(human chorionic gonadotropin, hCG)升高患者的临床特点和诊治意义。 方法 2011年8月至2015年3月北京协和医院诊断为持续性真性低水平hCG升高患者6例, 收集患者临床资料, 对疾病特点、诊治过程和随诊情况进行回顾性分析。 结果 6例患者中, 3例继发于葡萄胎清宫术后, 3例继发于侵蚀性葡萄胎化疗后。3例侵蚀性葡萄胎患者的中位总疗程数为8个, 均有化疗失败史。6例患者随诊中位时间为24个月, 自治疗结束至hCG呈低水平升高的中位时间为5.5个月, 低水平hCG升高持续的中位时间为16.5个月。4例患者病情稳定, 1例进展为绒毛膜癌, 1例自然妊娠分娩后hCG降至正常。 结论 持续性真性低水平hCG升高的持续时间较长, 对化疗不敏感, 应密切随诊, 不宜治疗。 Abstract:Objective To investigate the clinical characteristics and significance of diagnosis and treatment associated with persistent real low-level elevation of human chorionic gonadotropin (hCG). Methods Six patients diagnosed with persistent real low-level hCG elevation at Peking Union Medical College Hospital in the period from August 2011 to March 2015 were collected. Clinical records of the 6 patients were reviewed to retrospectively analyze clinical features, diagnosis and treatment approaches, and follow-up results. Results Among the 6 patients, 3 were secondary to uterine curettage for hydatidiform moles, and the other 3 had received chemotherapy for invasive moles, in whom the median chemotherapy cycle number was 8 and all experienced failure of at least one chemotherapy regimen. The median follow-up time was 24 months. The median period between the termination of treatment and the initial low-level hCG elevation was 5.5 months. The median duration of low-level hCG elevation was 16.5 months. Four patients had no evidence of progression, 1 patient progressed to choriocarcinoma, and 1 presented with the hCG level decreasing to the normal range after spontaneous delivery. Conclusion Persistent real low-level hCG elevation may persist for a long time and not respond to chemotherapy. Long-term close monitoring is necessary, but treatment is not recommended. -
表 1 真性低水平hCG升高患者临床和治疗特点
病例 年龄
(岁)原发
疾病治疗前
β-hCG
(U/L)总化疗
程数随诊时间
(月)治疗结束至hCG
呈低水平升高的
时间(月)低水平hCG
持续时间
(月)低水平β-hCG
中位值
(U/L)结局 1 41 IM Ⅲ期1分 2.2×105 7 23 8 15 6(5~11) 持续低水平 2 24 IM Ⅲ期0分 1.9×105 8 25 -3* 28 13(10~20) 完全缓解 3 30 HM 3.8×105 - 29 8 21 64(10~82) 进展为绒癌 4 40 IM Ⅰ期1分 1.4×105 11 5 1 4 77(56~130) 持续低水平 5 26 HM 0.3×105 - 21 3 18 7(5~12) 持续低水平 6 25 HM - 26 12 14 7(4~9) 持续低水平 *病例2患者4程化疗后β-hCG降至10 U/L,又巩固化疗4程,β-hCG无变化,因化疗停止前3个月β-hCG已呈低水平升高,故计为-3个月;hCG:人绒毛膜促性腺激素;IM:侵蚀性葡萄胎;HM:葡萄胎 -
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