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漫谈人绒毛膜促性腺激素

漫谈人绒毛膜促性腺激素. Human Chorionic Gonadotropin (hCG): The Story Of Pregnancy Hormone. 田永红. General introduction. 人绒毛膜促性腺激素 Human Chorionic Gonadotropin (hCG) MeSH Chorionic Gonadotropin Placental Hormones Pregnancy Proteins. General introduction.

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漫谈人绒毛膜促性腺激素

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  1. 漫谈人绒毛膜促性腺激素 Human Chorionic Gonadotropin (hCG): The Story Of Pregnancy Hormone 田永红

  2. General introduction • 人绒毛膜促性腺激素 • Human Chorionic Gonadotropin (hCG) • MeSH • Chorionic Gonadotropin • Placental Hormones • Pregnancy Proteins

  3. General introduction • hCG是由胎盘的滋养层组织合成，然后分泌进入母体和胎儿的血液中。hCG是一种小分子，在母体中很容易通过肾小球，进入尿液而被排除，因此测定母体尿液之hCG • 血清中hCG的浓度大约等于早晨初次尿的浓度，而随机采取的稀薄尿液之hCG浓度略低于血清中的浓度

  4. General introduction • 类似LH维持黄体，分泌孕酮, 子宫内膜分泌期,妊娠得以继续 • hCG也能促使胎儿与胎盘的类固醇生成(steroidogenesis)，并能刺激男性胎儿睾丸分泌睾酮(testosterone) • 血hCG最早可在受精后6天,尿hCG于12-14天检测到 • 倍增时间:约48-72 h,妊娠时间的延长增高,倍增时间增至 96 h。妊娠8 - 10 w高峰,然后保持此水平直至结束

  5. General introduction • 和FSH、LH、TSH一样，均由α和β两个亚单位组成。α亚单位中的氨基酸组成及序列基本相同，免疫反应也基本相同，特异性存在于β亚单位 • 放免检测血β-HCG，灵敏的早早孕方法。

  6. Key things about hCG levels (1) • 对hCG水平得的出的结论应慎重: 即便较低的hCG水平仍然可以娩出健康的孩子 • 超声测量较之hCG水平(5 - 6 妊娠周后 )更为准确

  7. Key things about hCG levels (2) • 两个实验: 定性实验和定量(beta hCG)实验 • The hCG hormone is measured in milli-international units per milliliter (mIU/ml) • 外周血水平< 5mIU/ml 阴性 > 25mIU/ml 妊娠实验阳性

  8. Key things about hCG levels (3) • 阴超可见妊娠囊 1,000 - 2,000mIU/ml • 在考虑到妊娠期间的健康问题时,单独的hCG判定是不够的,连续动态测量及其他手段进行评估是需要的 • 因其水平变异大,所以完全不能以其高低确定妊娠期结局

  9. Guideline to hCG levels during pregnancy • 3 weeks LMP: 5 - 50 mIU/ml • 4 weeks LMP: 5 - 426 mIU/ml • 5 weeks LMP: 18 - 7,340 mIU/ml • 6 weeks LMP: 1,080 - 56,500 mIU/ml • 7 - 8 weeks LMP: 7, 650 - 229,000 mIU/ml • 9 - 12 weeks LMP: 25,700 - 288,000 mIU/ml • 13 - 16 weeks LMP: 13,300 - 254,000 mIU/ml • 17 - 24 weeks LMP: 4,060 - 165,400 mIU/ml • 25 - 40 weeks LMP: 3,640 - 117,000 mIU/ml • Non-pregnant females: <5.0 mIU/ml

  10. False positive of hCG? • 血β-HCG的检测对诊断妊娠有非常高的特异性，假阳性的可能性极少，有几种情况: - 极少数妇女血液中存在针对动物抗原的抗hCG抗体，绝大多数与动物有密切接触 - 在促排卵治疗和应用辅助生殖技术的过程中，往往在黄体期肌注hCG - 患妊娠滋养细胞疾病后，患者体内存在异源性hCG抗体。

  11. What can a low hCG level mean? • A low hCG level can indicate : -计算错误 -流产可能(先兆流产) -异位妊娠 • rechecked within 48-72 hours to see how the level is changing.

  12. What can a high hCG level mean? • A high hCG level can indicate: -计算错误 -葡萄胎 -多胎妊娠 • rechecked within 48-72 hours to evaluate changes in the level.

  13. Should hCG level be checked routinely? • 除非有病理妊娠的可能性,无需测量 • 以下情况: - 阴道流血 - 腹痛(绞痛) - 流产史

  14. hCG levels after a pregnancy loss? • 大多数妇女中止妊娠4 - 6 weeks阴性(<5.0 mIU/ml) • 变化较大,取决于:如何发生 (自然流产, 人工中止妊娠, 自然分娩,2 weeks) ,原来水平高低 • 应检测测量至 <5.0 mIU/ml

  15. Applications • Prengnancy diagnosis • Ectopic pregnancy • Hydatidiform mole • GTN • PSTT • Assistant reproduction • Contraception

  16. Others • 正常早孕期4-8周，HCG水平2－3d增加一倍。 • LMP至7周，腹部超生可以看到胎囊及胎心搏动，HCG约20000mU/ml。 • 孕9-10周孕酮是平稳的，预测妊娠结局：<5ng/ml可能不良结局（自然流产或异位妊娠），>25ng/ml提示宫内妊娠存活。

  17. Others

  18. Others • 孕8-13周之间可以看到胚胎，可通过测量头臀长计算孕周：孕周＝头臀长(cm)＋6.5 • 一个平均直径2cm的妊娠囊应该有胚胎，一个头臀长5mm的胚胎应该有胎心

  19. The End THANKS FOR YOUR ATTENTION!

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