摘要
目的分析人绒毛膜促性腺激素(hCG)持续性低水平升高误诊原因及防范措施。方法回顾性分析2022年5月—2023年12月收治的2例初诊误诊的hCG持续性低水平升高临床资料。结果1例因停经伴血hCG值升高4月余,化疗后未见血hCG值下降就诊;1例因人工流产后50 d,异常子宫出血4 d就诊。超声检查1例提示无异常,1例发现宫腔异常回声及子宫肌层低阻回声。1例初诊为妊娠滋养细胞疾病(GTD)予甲氨蝶呤联合甲酰四氢叶酸方案化疗2个周期;1例初诊为子宫动静脉瘘+妊娠物残留,予子宫动脉造影联合宫腔镜诊断性刮宫。1例化疗后未见血hCG值下降;1例造影结果阴性,宫内物病理检查未见妊娠物。2例均确诊为原发性hCG持续性低水平升高,未予特殊处理。结论hCG持续性低水平升高临床少见、表现不典型,若未行血尿hCG检查、性激素检查或未仔细分辨超声图像特征,极易与滋养细胞疾病等混淆。接诊医生应提高本病警惕性,加强对本病的认识,对有停经史、异常子宫出血者应及早行血尿hCG、超声及磁共振检查,仔细询问病史,必要时纳入性激素全套及卵巢功能检测以明确诊断。
Objective To analyze the causes of misdiagnosis and preventive measures of elevated human chorionic gonadotropin(hCG)with persistently low levels.Methods The clinical data of 2 patients with elevated hCG with persistent low levels initially misdiagnosed and admitted from May 2022 to December 2023 were retrospectively analyzed.Results One patient presented with menopausal and increased hCG level for 4 months,but no decrease in blood hCG level after chemothera-py.One patient presented with abnormal uterine bleeding for 4 d and at 50 d after induced abortion.Ultrasonography showed no abnormality in 1 patient,and abnormal uterine echo and low resistance of myometrium echo in 1 patient.One patient was initially diagnosed with gestational trophoblastic disease(GTD)and received 2 cycles of chemotherapy with Methotrexate com-bined with Formyltetrahydrofolate regimen.One patient was initially diagnosed with uterine arteriovenous fistula+gestational residue,and was treated with uterine arteriography combined with hysteroscopic diagnostic curettage.One patient did not have a decrease in hCG level after chemotherapy.One patient had negative angiography results,and no pregnancy was found in his-topathological examination of intrauterine matter.It was confirmed that the primary hCG level with persistently low level was elevated in two patients,who,however,did not receive specific treatment.Conclusion The elevated serum hCG with per-sistently low level is rare and atypical in clinical setting.If hCG examination in hematuria,sex hormone examination or careful distinguishment of ultrasound image features are not performed,it is more likely to be confused with other diseases such as trophoblastic diseases.The doctor should enhance the vigilance of this disease and strengthen the understanding of this dis-ease.For those with a history of menopausal and abnormal uterine bleeding,hematuria hCG,ultrasound and magnetic reso-nance examination should be performed as soon as possible,and the medical history should be carefully inquired.If necessa-ry,a full set of sex hormones and ovarian function test should be included to confirm the diagnosis.
作者
王子昭
黎秋红
朱顺鹏
钱珺
周金华
WANG Zizhao;LI Qiuhong;ZHU Shunpeng;QIAN Jun;ZHOU Jinhua(Department of Obstetrics and Gynecology,the First Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215026,China)
出处
《临床误诊误治》
CAS
2024年第9期6-10,共5页
Clinical Misdiagnosis & Mistherapy
基金
江苏省重点研发计划(社会发展)项目(BE2022729)。
关键词
绒毛膜促性腺激素
误诊
妊娠滋养细胞疾病
子宫动静脉瘘
黄体生成素
促卵泡激素
宫腔镜检查
Chorionic gonadotropin
Misdiagnosis
Gestational trophoblastic disease
Arteriovenous fistula
Luteini-zing hormone
Follicle-stimulating hormone
Hysteroscopy
