摘要
目的探讨经阴道彩色多普勒超声(CDFI)检查结合血清β亚单位绒毛膜促性腺激素(β-HCG)在妊娠滋养细胞疾病(GTD)诊治中的应用价值。
方法对41例GTD患者治疗前后子宫附件行二维及彩色多普勒超声检查,测量病灶处收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)、阻力指数(RI)等血流参数。用化学发光法测定良、恶性GTD治疗前、后血清β-HCG值。
结果良性GTD子宫二维声像图表现不典型,而恶性GTD表现多样化。治疗前GTD病灶处PSV、EDV与血清β-HCG呈低度正相关(r=0.131～0.242，P<0.05),R工与血清β-HCG呈低度负相关(r=-0.296,P<0.05)。恶性GTD病灶处PSV、EDV明显高于良性GTD, RI明显低于良性GTD,差异有统计学意义(P<0.05)；鉴别良、恶性GTD的RI最佳临界点为0.43,灵敏度为82.1%,特异度为76.9%。恶性GTD化疗结束后,子宫、病灶及黄素囊肿大小及病灶异常血流丰富区的范围均缩小,血清β-HCG水平下降；与化疗前比较,疗效显著型GTD化疗后RI明显上升,而血清β-HCG明显下降,差异有统计学意义(P<0.05)；疗效不显著型化疗后血清β-HCG明显下降,化疗前后血清β-HCG比较差异有统计学意义(P<0.05),而化疗前后RI比较差异无统计学意义(P>0.05)。
结论经阴道CDFI结合血清β-HCG检查是诊断GTD的重要方法,对恶性GTD患者化疗效果的评估及指导临床治疗具有临床价值。
Objective To evaluate the combination of transvaginal color Doppler flow imaging(CDFI) and measurement of serumβsubunit of human chorionic gonadotropin (β-HCG) in the application of gestational trophoblastic disease(GTD).
Methods Flow parameters included peak systolic velocity(PSV), end diastolic velocity(EDV), resistance index(RI) on lesions for 41 patients with GTD before and after chemotherapy were measured by the two-dimensional ultrasound and CDFI on uterus and accessories. Serumβ-HCG of benign and malignant GTD before treatment was tested by chemiluminescence.
Results Ultrasonography on uterus of benign GTD was untypical, while malignant GTD's was diverse. There was low positive correlation between peak systolic velocity (PS V), end diastolic velocity (ED V) on lesions GTD and serumβ-HCG before treatment(r=0.131～0.242, P<0.05), low negative correlation between resistance index(RI) and serumβ-HCG(r=-0.296, P<0.05). The result showed PSV, EDV in malignant group was significantly higher than those in benign GTD, however, while the RI was significantly lower than that of benign GTD, there were statistical differences in the PSV, EDV and RI (P<0.05). To distinguish benign GTD from malignant ones, the best RI's cut-off point, sensitivity and specificity are separately 0.43,82.1% and 76.9%. The size of uterus, lesions, flabvin cyst and the unusual rich blood flow area reduced, the level of serumβ-HCG decreased after chemotherapy of malignant lesions GTD. Comparing data before chemotherapy, the RI in the type with signifycant effect increased after chemotherapy, while serumβ-HCG decreased, there were statistical differences in them(P<0.05); serumβ-HCG in the type with no significant effect after chemotherapy significantly decreased after chemotherapy, there was statistical difference in serumβ-HCG before and after chemotherapy (P<0.05), while there was none in the RI (P>0.05)
Conclusion The combination of transvaginal CDFI and serumβ-HCG is a important method, which is very significant value on assessing the effect of chemotherapy and guiding the clinical treatment for patients with malignant GTD.
引文
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