| Ectopic pregnancy(EP) is one of acute abdomen diseases in department of Obstetrics & Gynecology. In rencent 30 years, the incidence of EP has increased rapidly. The hemorrhage of ruptured EP is one of the most common causes of death in early pregnancy in women. It is very important to make an early diagnosis on this kind of disease. The earlier it is diagnosed, the less danger it will produce. Early diagnosis can not only prevent EP rupturing, but also reduce the danger of operation.With the development of technology, there are diverse methods for EP diagnosis. The routine accessory methods include urine's pregnancy test, detection of serum human chorionic gonadotropin (hCG) and it's β-subunit, transabdominal sonography (TAS) and transvaginal sonography (TVS), gynecologic examination and diagnostic curettage of uterus, etc. These methods are effective but not very specific in the diagnosis, so it is necessary to find other methods for it.There are at least five kinds of patterns of hCG in human's blood. It includes hCG,α-subunit,β-subunit, free-β-subunit, β-core fragment, H-hCG and hCGn. Free-β-subunit is the unbinded β-subunit and polypeptide of 23kd. Ozturk reported that it was higher in women with malignancy gestational trophoblastic tumor than those with normal pregnancy, which indicated the immaturity of the trophoblastic cell. The detection of hCG and it,s β- subunits is a very mature method in diagnosis EP in clinic. The traditional therapeutic method of EP is operation, but it brings more wound than non-operative treatment. With the improvement of people's living standard and the progress in medical science, more and more people choose less injury operation such as laparoscope or conservative therapy with drugs, because they can better reserve fertility. It is the tendency to choose non-operative treatment of EP. In our clinical work, it is a challenge for doctors to choose the most suitable method for various cases. My study was to observe the changes of hCG, β-hCG and free-β-hCG in EP patients, abortion and normal pregnancy. There are three parts in my study. In the first part, we detected three kinds of hCG in patients. β-hCG was detected by radioimmunoassay, hCG and F-β-hCG were detected by chemiluminescent immunoassay. The serum was acquired from 96women with early pregnancy, 102 women with abortion and 147 women of ectopic pregnancy in our hospital. In the second part, all the women of ectopic pregnancy were examined with B sonograph and part of them were examined with diagnostic curettage of uterus. In the third part ,we chose different tubal pregnancies to observe the infiltration of trophoblastic cells. Results and Conclusions :1. F-β-hCG was higher in patients of EP than in that of women with abortion and normal pregnancy. F-β-hCG was higher in patients of rupture of tubal pregnancy than in that of tubal abortion. Tubal was invasived in the different depths by trophoblastic cells according to the different F-β-hCG levels. When F-β-hCG was 5.3 ng/ml,the sensitivity was 96% in dignosing ruptured tubal pregnancy. F-β-hCG could be a predicting marker for ruptured tubal pregnancy.2. F-β-hCG was different in EP of operation and conservative therapy. When F-β-hCG was 4.7 ng/ml,hCG was 3196.30mIu/ml,β-hCG was 14.92ng/ml,It was safer to treat the patients of ectopic pregnancy with operation. 3. Pathologic type of endometrium was related to the level of β-hCG which changed from the proliferative phase to the secretory phase and to the decidual and A-S phase . The longer the menolipsis time was and the higher theβ-hCG was, the more decidual and A-S phase was. |
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