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目的探讨妊娠相关血浆蛋白A(PAPP-A)对妊娠滋养细胞疾病(GTD)的诊断及预后价值。方法2002-2005对西安交通大学第一医院25例正常孕妇、28例完全性葡萄胎及38例侵蚀性葡萄胎采用酶联免疫吸附法(ELISA)检测治疗前、治疗中以及随访过程中的血清PAPP-A,同时检测血清β-HCG水平。结果葡萄胎组及侵蚀性葡萄胎组血清β-HCG水平均高于对照组(P<0.05),但葡萄胎组与侵蚀性葡萄胎组间β-HCG差异无统计学意义(P>0.05)。葡萄胎组血清PAPP-A显著高于对照组(P<0.05),侵蚀性葡萄胎组血清PAPP-A显著高于对照组及葡萄胎组(P<0.05)。葡萄胎恶性转归组血清β-HCG和PAPP-A均明显高于良性转归组(P<0.05)。β-HCG水平与侵蚀性葡萄胎临床分期无关,而PAPP-A与临床分期呈正相关。良性葡萄胎清宫术后β-HCG和PAPP-A均呈下降趋势,恶变时β-HCG和PAPP-A略有升高或持续阳性。结论PAPP-A检测可能早期诊断良、恶性葡萄胎,并有助于早期预测葡萄胎恶变。
Objective To investigate the value of pregnancy-associated plasma protein A (PAPP-A) in the diagnosis and prognosis of gestational trophoblastic disease (GTD). Methods From 2002 to 2005, 25 pregnant women, 28 complete hydatidiform mole and 38 invasive hydatidiform mole in the First Hospital of Xi’an Jiaotong University were enrolled in this study. Serum before treatment, during treatment and during follow-up were detected by enzyme-linked immunosorbent assay (ELISA) PAPP-A, while serum β-HCG levels were measured. Results The serum levels of β-HCG in hydatidiform mole and invasive hydatidiform mole group were higher than those in control group (P <0.05), but the difference of β-HCG between hydatidiform mole group and invasive hydatidiform mole group was not statistically significant (P> 0.05) . The level of PAPP-A in hydatidiform mole group was significantly higher than that in control group (P <0.05). The PAPP-A level in hydatidiform mole group was significantly higher than that in control group and hydatidiform mole group (P <0.05). The serum levels of β-HCG and PAPP-A in the hydatidiform mole malignant outcome group were significantly higher than those in the benign outcome group (P <0.05). The level of β-HCG was not related to the clinical stage of invasive hydatidiform mole, while PAPP-A was positively correlated with clinical stage. The levels of β-HCG and PAPP-A in patients with benign hydatidiform mole after radical hysterectomy showed a decreasing trend, while the levels of β-HCG and PAPP-A slightly increased or remained positive in malignant patients. Conclusions PAPP-A test may diagnose benign and malignant mole early, and help to predict early hydatidiform mole malignant transformation.