终末期肾病导致的β-hCG清除障碍一例

doi:10.12280/gjfckx.20251360

摘要/Abstract

摘要：

报告1例终末期肾病（end-stage renal disease，ESRD）伴人绒毛膜促性腺激素β亚单位（β-human chorionic gonadotropin，β-hCG）异常升高的罕见病例，分析其临床特征、诊断思路及β-hCG升高的潜在机制，旨在提高对ESRD患者非妊娠、非肿瘤性β-hCG升高的认识。患者为35岁女性，维持性血液透析（maintenance hemodialysis，MHD）治疗7年余，因停经6个月余入院。实验室检查示血β-hCG升高，妇科超声检查未见明显妊娠迹象，初始考虑异位妊娠，经全面排查均被排除。结合文献复习，考虑为ESRD导致的肾脏清除功能下降所致的β-hCG升高。予继续MHD治疗，定期监测β-hCG，无新发症状。本病例提示，ESRD患者出现β-hCG升高时，需首先通过详细病史、影像学及实验室检查排除妊娠、肿瘤等常见病因，同时应考虑肾功能衰竭对β-hCG代谢的影响。临床医生需拓宽诊断思维，避免误诊，推动ESRD并发症的精准诊疗。

关键词: 终末期肾病, 绒毛膜促性腺激素，β亚单位，人, 连续性肾替代疗法, 妊娠，异位, 妊娠滋养细胞疾病

Abstract:

This report presents a rare case of end-stage renal disease (ESRD) with abnormally elevated β-human chorionic gonadotropin (β-hCG), analyzes its clinical characteristics, diagnostic considerations, and the potential mechanism underlying β-hCG elevation, aiming to raise awareness of non-pregnancy and non-neoplastic β-hCG elevation in ESRD patients. The patient is a 35-year-old woman who had been on maintenance hemodialysis (MHD) for more than 7 years and was admitted due to amenorrhea lasting over 6 months. Laboratory tests showed elevated serum β-hCG. Gynecological ultrasound showed no signs of pregnancy. Ectopic pregnancy was initially suspected but ruled out after comprehensive evaluation. Based on literature review, the β-hCG elevation was considered to result from reduced renal clearance caused by ESRD. The patient continued MHD treatment with regular β-hCG monitoring and developed no new symptoms. This case indicates that when β- hCG is elevated in ESRD patients, it is essential to first exclude common etiologies such as pregnancy and neoplasms through detailed history, imaging, and laboratory examinations, while also considering the impact of renal failure on β-hCG metabolism. Clinicians should broaden diagnostic thinking to avoid misdiagnosis and promote precise diagnosis and management of complications in ESRD.

Key words: End-stage renal disease, Chorionic gonadotropin, beta subunit, human, Continuous renal replacement therapy, Pregnancy, ectopic, Gestational trophoblastic disease

肖金芬, 张旭梅, 刘懿, 曾倩, 张雯莹. 终末期肾病导致的β-hCG清除障碍一例[J]. 国际妇产科学杂志, 2026, 53(3): 357-360.

XIAO Jin-fen, ZHANG Xu-mei, LIU Yi, ZENG Qian, ZHANG Wen-ying. Impaired β-hCG Clearance Due to End-Stage Renal Disease: A Case Report[J]. Journal of International Obstetrics and Gynecology, 2026, 53(3): 357-360.

图/表 1

参考文献 12

[1]	Derakhshan A, Shu H, Broeren M, et al. Association of endocrine disrupting chemicals exposure with human chorionic gonadotropin concentrations in pregnancy[J]. Environ Int, 2023, 178:108091. doi: 10.1016/j.envint.2023.108091.
[2]	Herghelegiu CG, Veduta A, Stefan MF, et al. Hyperglycosylated-hCG: Its Role in Trophoblast Invasion and Intrauterine Growth Restriction[J]. Cells, 2023, 12(12):1647. doi: 10.3390/cells12121647.
[3]	Cole LA, Gutierrez JM. Production of human chorionic gonadotropin during the normal menstrual cycle[J]. J Reprod Med, 2009, 54(4):245-250. doi: 10.1038/jp.2009.7. pmid: 19438167
[4]	Cole LA, Laidler LL, Muller CY. USA hCG reference service, 10-year report[J]. Clin Biochem, 2010, 43(12):1013-1022. doi: 10.1016/j.clinbiochem.2010.05.006. pmid: 20493830
[5]	Komarnicki P, Gut P, Cieślewicz M, et al. Serum β-hCG as a Biomarker in Pancreatic Neuroendocrine Tumors: Rethinking Single-Analyte Approach[J]. Cancers(Basel), 2024, 16(11):2060. doi: 10.3390/cancers16112060.
[6]	Rani BS, Suchitra MM, Srinivasa Rao P, et al. Serum tumor markers in advanced stages of chronic kidney diseases[J]. Saudi J Kidney Dis Transpl, 2019, 30(4):898-904. doi: 10.4103/1319-2442.265466. pmid: 31464247
[7]	Chan GC, Kalantar-Zadeh K, Ng JK, et al. Frailty in patients on dialysis[J]. Kidney Int, 2024, 106(1):35-49. doi: 10.1016/j.kint.2024.02.026.
[8]	Flythe JE, Watnick S. Dialysis for Chronic Kidney Failure: A Review[J]. JAMA, 2024, 332(18):1559-1573. doi: 10.1001/jama.2024.16338. pmid: 39356511
[9]	Haninger-Vacariu N, Herkner H, Lorenz M, et al. Exclusion of pregnancy in dialysis patients: diagnostic performance of human chorionic gonadotropin[J]. BMC Nephrol, 2020, 21(1):70. doi: 10.1186/s12882-020-01729-5. pmid: 32111190
[10]	Reimann F, Tomlins M. Prescribing and peritoneal dialysis[J]. Aust Prescr, 2023, 46(1):5-8. doi: 10.18773/austprescr.2023.001. pmid: 38053668
[11]	ACOG Clinical Consensus No. 11: Management of Positive Human Chorionic Gonadotropin Test Results in Nonpregnant Patients Without Gynecologic Malignancy[J]. Obstet Gynecol, 2026, 147(2):e32-e38. doi: 10.1097/AOG.0000000000006155.
[12]	Gehin JE, Klaasen RA, Norli ES, et al. Rheumatoid factor and falsely elevated results in commercial immunoassays: data from an early arthritis cohort[J]. Rheumatol Int, 2021, 41(9):1657-1665. doi: 10.1007/s00296-021-04865-9. pmid: 33944985

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