双胎之一完全性葡萄胎六例临床分析

doi:10.12280/gjfckx.20220945

摘要/Abstract

摘要：

目的：探讨双胎之一完全性葡萄胎（complete hydatidiform mole with co-existing fetus，CHMCF）的临床特征、诊断及处理。方法：回顾性分析2019年1月—2021年12月郑州大学第一附属医院收治的6例CHMCF患者的临床资料，采用描述性方法对数据进行分析。结果：6例CHMCF孕妇的年龄为（27.8±5.3）岁，中位妊娠次数3（1~6）次，中位发现孕周为14⁺¹周（8⁺⁵~24周）。4例妊娠期反复阴道出血，2例出现妊娠剧吐，1例出现甲状腺功能亢进。6例患者中位血清人绒毛膜促性腺激素β亚单位（human chorionic gonadotrophin-β，β-hCG）最高值为389 527（225 354~1 323 961） U/L；5例超声提示妊娠合并葡萄胎，1例超声提示部分性葡萄胎。1例行产前诊断未发现异常，其余病例拒绝产前诊断。4例因反复阴道出血引产，1例于妊娠早期发现要求流产，1例于妊娠36周剖宫产分娩一活女婴。6例大体病理检查均显示为两个分离的组织，一个为正常胎盘，一个为葡萄胎。正常胎盘绒毛发育良好，葡萄胎绒毛水肿。短串联重复序列（short tandem repeat，STR）基因检测均显示葡萄胎组织为单精空卵（纯合型），符合完全性葡萄胎。随访6例患者均未继发妊娠滋养细胞肿瘤，中位β-hCG转阴的时间为2.5（2~6）个月。结论：CHMCF病例较为罕见，正确诊断对预后有重要临床意义，STR基因检测对诊断有一定帮助。

关键词: 妊娠, 双胎, 葡萄胎, 胎儿, 共生, 基因检测

Abstract:

Objective: To investigate the clinical characteristics, diagnosis and management of complete hydatidiform mole with co-existing fetus (CHMCF). Methods: The clinical data of 6 cases of twin pregnancy consisting of a CHMCF admitted to the First Affiliated Hospital of Zhengzhou University, from January 2019 to December 2021 were retrospectively analyzed, and the data were analyzed by descriptive methods. Results: The mean age of the six patients were (27.8±5.3) years old, with 3 (1-6) times of pregnancies. Six cases were identified at 14⁺¹ (8⁺⁵-24) gestational weeks. Recurrent vaginal bleeding during pregnancy occurred in 4 cases, nausea and vomiting in 2 cases, and hyperthyroidism in mid-pregnancy in a case. In the 6 patients, the summit serum human chorionic gonadotrophin-β (β-hCG) level was 389 527 (225 354-1 323 961) U/L. The ultrasound results revealed that 5 cases of CHMCF, and a case was partial hydatidiform mole. Prenatal diagnosis is normal in a case, which was refused in the remaining cases. Four cases were induced due to recurrent vaginal bleeding, a case was found to require abortion in early pregnancy, and a case was delivered by cesarean section at 36 weeks of gestation. The gross examination of all 6 cases showed two separate tissues, one was normal placental and the other was mole. Normal placental villi were well developed with hydatidiform mole villi edematous. All short tandem repeat (STR) gene detections showed that the mole tissue was homozygous, conforming to complete mole. None of the 6 patients developed gestational trophoblastic neoplasia, and the median time of β-hCG turning negative was 2.5 (2-6) months. Conclusions: CHMCF is rare. Correct diagnosis is of great clinical significance for prognosis. STR gene detection can help confirm the diagnosis.

Key words: Pregnancy, twin, Hydatidiform mole, Fetus, Symbiosis, Genetic testing

李灵燕, 赵先兰. 双胎之一完全性葡萄胎六例临床分析[J]. 国际妇产科学杂志, 2023, 50(2): 142-146.

LI Ling-yan, ZHAO Xian-lan. Clinical Analysis of Six Cases of Complete Hydatidiform Mole with Co-Existing Fetus[J]. Journal of International Obstetrics and Gynecology, 2023, 50(2): 142-146.

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参考文献 16

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病列	年龄（岁）	孕产史	妊娠方式	发现孕周（周）	临床表现	β-hCG最高值（U/L）	彩色超声结果
例1	34	孕4产1	IVF-ET	8⁺⁵	妊娠剧吐	383 035	CHMCF^①
例2	22	孕1产0	自然妊娠	13⁺¹	反复阴道出血	396 020	CHMCF^②
例3	30	孕6产3	促排卵	13⁺⁵	反复阴道出血	702 774	CHMCF^③
例4	28	孕3产2	自然妊娠	14⁺⁴	反复阴道出血	225 354	部分性葡萄胎^④
例5	32	孕3产2	自然妊娠	17	反复阴道出血、甲状腺功能亢进	1 323 961	CHMCF^⑤
例6	21	孕1产0	自然妊娠	24	妊娠剧吐	316 118	CHMCF^⑥

病列	年龄（岁）	孕产史	妊娠方式	发现孕周（周）	临床表现	β-hCG最高值（U/L）	彩色超声结果
例1	34	孕4产1	IVF-ET	8⁺⁵	妊娠剧吐	383 035	CHMCF^①
例2	22	孕1产0	自然妊娠	13⁺¹	反复阴道出血	396 020	CHMCF^②
例3	30	孕6产3	促排卵	13⁺⁵	反复阴道出血	702 774	CHMCF^③
例4	28	孕3产2	自然妊娠	14⁺⁴	反复阴道出血	225 354	部分性葡萄胎^④
例5	32	孕3产2	自然妊娠	17	反复阴道出血、甲状腺功能亢进	1 323 961	CHMCF^⑤
例6	21	孕1产0	自然妊娠	24	妊娠剧吐	316 118	CHMCF^⑥

病例	终止妊娠孕周（周）	终止妊娠方式	终止原因	病理检查	STR	GTN	β-hCG转阴时间（个月）
例1	9⁺¹	清宫术	个人原因放弃	水泡状胎块	单精空卵（纯合型）	否	2
例2	15⁺⁶	引产+钳夹+清宫术	反复阴道出血	水泡状胎块	单精空卵（纯合型）	否	3
例3	14⁺¹	引产+清宫术	反复阴道出血	水泡状胎块	单精空卵（纯合型）	否	3
例4	14⁺⁶	引产+清宫术	反复阴道出血	水泡状胎块	单精空卵（纯合型）	否	2
例5	17⁺⁴	引产+剖宫取胎术	反复阴道出血	水泡状胎块	单精空卵（纯合型）	否	6
例6	36	剖宫产娩一活婴	个人要求	水泡状胎块	单精空卵（纯合型）	否	2

病例	终止妊娠孕周（周）	终止妊娠方式	终止原因	病理检查	STR	GTN	β-hCG转阴时间（个月）
例1	9⁺¹	清宫术	个人原因放弃	水泡状胎块	单精空卵（纯合型）	否	2
例2	15⁺⁶	引产+钳夹+清宫术	反复阴道出血	水泡状胎块	单精空卵（纯合型）	否	3
例3	14⁺¹	引产+清宫术	反复阴道出血	水泡状胎块	单精空卵（纯合型）	否	3
例4	14⁺⁶	引产+清宫术	反复阴道出血	水泡状胎块	单精空卵（纯合型）	否	2
例5	17⁺⁴	引产+剖宫取胎术	反复阴道出血	水泡状胎块	单精空卵（纯合型）	否	6
例6	36	剖宫产娩一活婴	个人要求	水泡状胎块	单精空卵（纯合型）	否	2