天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (2): 217-220.doi: 10.11958/59134

• 临床研究 • 上一篇    下一篇

VEGF 和β-HCG 与输卵管妊娠滋养细胞侵入管壁深度的 关联性研究

王东杰， 吴香， 吴晓梅   

  1. 云南省第一人民医院妇科 （邮编 650034）
  • 收稿日期:2015-06-23 修回日期:2015-10-04 出版日期:2016-02-15 发布日期:2016-02-15

Vascular endothelial growth factor and β-human chorionic gonadotropin are associated with trophoblastic invasion into the tubal wall in ectopic pregnancy

WANG Dongjie, WU Xiang, WU Xiaomei   

  1. Department of Gynecology, First People′s Hospital of Yunnan Province, Kunming 650034, China
  • Received:2015-06-23 Revised:2015-10-04 Published:2016-02-15 Online:2016-02-15

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摘要： 目的 评估输卵管壶腹部妊娠患者滋养细胞浸润输卵管壁深度与血管内皮生长因子 （VEGF） 及β-人绒毛膜促性腺激素（β-HCG）血清浓度之间的关联性。方法 选择输卵管壶腹部妊娠且已行患侧输卵管切除术患者 80 例。手术当天检测血清 VEGF 和β-HCG 浓度。血清 VEGF 含量的测定采用 ELISA 法。留取切除的患侧输卵管及妊娠组织， 输卵管肌纤维用 Masson 染色， 滋养细胞用人胎盘催乳素 （HPL） 免疫组织化学染色。依据术后病理结果中滋养细胞浸入输卵管壁的深度， 将 80 例患者分为Ⅰ～Ⅲ期。血清β-HCG 采用双抗体夹心光化学测定法。结果 Ⅰ 期血清 VEGF 和β-HCG 浓度的平均值明显低于Ⅱ期， 而Ⅱ期明显低于Ⅲ期 （P＜0.05）。Ⅰ期和Ⅱ期临界值 VEGF 浓度为 308.6 ng/L， 敏感度 100.0%， 特异度 92.6%， Ⅱ期和Ⅲ期临界值 VEGF 浓度为 431.9 ng/L， 敏感度 79.3%， 特异度 79.2%； Ⅰ期和Ⅱ期临界值β-HCG 浓度为 2 509.6 IU/L， 敏感度 91.7%， 特异度 81.5%， Ⅱ期和Ⅲ期临界值β-HCG 浓度为 13 142.6 IU/L， 敏感度 72.4%， 特异度 95.8%。结论 输卵管妊娠患者血清中的 VEGF 和β-HCG 浓度与滋养细胞浸润输卵管壁深度有关， 可作为妊娠滋养细胞浸润输卵管管壁深度组织学分期的评估指标。

关键词: 血管内皮生长因子类, 绒毛膜促性腺激素, β亚单位, 人, 妊娠, 输卵管, 滋养细胞, ROC 曲线

Abstract: Objective To assess the association between the depth of trophoblastic penetration into the tubal wall with serum concentrations of vascular endothelial growth factor (VEGF) and β-human chorionic gonadotropin (β-HCG). Methods Eighty patients with a diagnosis of tubal pregnancy in the ampullary region underwent radical surgical treatment (sal⁃ pingectomy), were included in this study. The serum levels of VEGF and β-HCG were detected on the day of surgery. The se⁃ rum level of VEGF was measured by ELISA. The serum level of β-HCG was quantified with a two-site immunofluorimetric assay based on the direct sandwichtechnique. Histological material was stained with Masson′s trichrome to identify muscular fibers. Immunohistochemical staining was used for human placental lactogen (hPL) to identify intermediate trophoblast and determine the depth of trophoblastic invasion into the tubal wall. The ampullary pregnancies were classified histologically according to the depth of trophoblastic infiltration into the tubal wall. Results The mean serum values of VEGF and β-HCG were significantly lower in patients with stage I tubal infiltration than those of stage Ⅱ, and which were significantly lower in patients with stage Ⅱ than those in stage Ⅲ (P＜0.05). The threshold serum value of VEGF was 308.6 ng/L, the sensitivity was 100.0% and the specificity was 92.6% for stageⅠand stage Ⅱ. The threshold serum value of VEGF was 431.9 ng/L, the sensitivity was 79.3% and specificity was 79.2% for stage Ⅱ and Ⅲ. The threshold serum value of β-hCG was 2 509.6 IU/L, the sensitivity was 91.7% and specificity was 81.5% for stageⅠ and stage Ⅱ, and levels of 13 142.6 IU/L, 72.4% and 95.8% for stage Ⅱ and stage Ⅲ. Conclusion The depth of trophoblastic penetration into the tubal wall is associated with maternal serum concentrations of VEGF and β-HCG, which can be used as the evaluation index for histological staging of trophoblas⁃ tic tissue infiltration.

Key words: vascular endothelial growth factors, chorionic gonadotropin, beta subunit, human, pregnancy, tubal, tropho? blastic cell, ROC curve