葡萄胎恶变相关危险因素的分析研究  

The analysis of risk factors associated with malignant transformation of hydatidiform mole

作　　者：白云[1] 赵郡 张雅静 张艺玮[1] 郭钊军 冯玉珍[1] Bai Yun;Zhao Jun;Zhang Yajing;Zhang Yiwei;Guo Zhaojun;Feng Yuzhen(Department of Obstetrics and Gynecology,Hebei Medical University Third Hospital,Shi Jiazhuang Hebei 050000,P.R.China)

机构地区：[1]河北医科大学第三医院妇产科,河北石家庄050000

出　　处：《中国计划生育和妇产科》2023年第12期69-72,78,共5页Chinese Journal of Family Planning & Gynecotokology

基　　金：河北省医学科学研究课题计划(项目编号:20201004)。

摘　　要：目的探究并分析与葡萄胎恶变相关的临床危险因素,以提高对葡萄胎恶变的早期预测。方法收集2011年1月至2022年12月因葡萄胎于河北医科大学第三医院首诊的218例患者的临床病理资料,根据是否恶变将所有患者分为非恶变组和恶变组,进行葡萄胎恶变相关因素分析。结果葡萄胎恶变率为19.27%(42/218),非恶变组和恶变组年龄、妊娠次数、子宫异常增大、卵巢黄素化囊肿、清宫术前血清β-hCG水平、葡萄胎病理类型、二次清宫、清宫术后24 h血清β-hCG未呈对数下降比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄≥40岁、妊娠次数>2次、卵巢黄素化囊肿、清宫术前血清β-hCG>10~5 mIU/mL、清宫术后24 h血清β-hCG未呈对数下降为葡萄胎恶变的独立危险因素(P<0.05)。ROC曲线分析得出年龄、卵巢黄素化囊肿及清宫术前血清β-hCG水平对葡萄胎恶变预测的阈值分别为37岁、3.55 cm、178671.0 mIU/mL。结论葡萄胎恶变与年龄、妊娠次数、卵巢黄素化囊肿、清宫术前血清β-hCG水平及清宫术后血清β-hCG下降情况相关。Objective To explore and analyse the clinical risk factors associated with malignant transformation of hydatidiform mole(HM),so as to improve early prediction of malignant transformation of hydatidiform mole.Methods Collected clinical and pathological data of 218 patients who were first diagnosed with HM at Hebei Medical University Third Hospital from January 2011 to December 2022,and divide all patients into a non malignant group and a malignant group based on whether they have undergone malignant transformation.Analyzed the related factors of HM malignant transformation.Results The incidence of gestational trophoblastic tumor after HM was 19.27%(42/218).Age,number of pregnancies,abnormal uterine enlargement,luteinized ovarian cysts,and serum β-hCG level before curettage,pathological type of HM,secondary curettage,and serum β-hCG with no logarithmic decreased 24-hour after curettage in the non malignant and malignant transformation groups was statistically different(P<0.05).Logistic regression analysis showed that age≥40 years old,number of pregnancies>2,luteinized cyst of ovary,serum β-hCG level before evacuation>10^(5)mlU/mL,Serum 24-hours after uterine curettage β-hCG does not show a logarithmic decrease were independent risk factors for malignant degeneration of HM(P<0.05).ROC curve analysis showed that the malignant predicting thresholds of age,luteinized cyst of ovary and serum β-hCC level before evacuation were 37 years old,3.55 cm and 178671.0 mIU/mL,respectively.Conclusions The age,number of pregnancies,luteinized cyst of ovary,serum β-hCG level before evacuation,and logarithmicde creased β-hCG are the main risk factors that affect the malignant transformation of HM.

关 键 词：葡萄胎 恶变 危险因素 妊娠滋养细胞肿瘤 

分 类 号：R737.3[医药卫生—肿瘤]