(Luận án tiến sĩ) nghiên cứu giá trị của beta hCG tự do và hCG toàn phần huyết thanh trong bệnh nguyên bào nuôi

BỘ GIÁO DỤC VÀ ĐÀO TẠO BỘ Y TẾ TRƯỜNG ĐẠI HỌC Y HÀ NỘI MAI TRỌNG DŨNG NGHIÊN CỨU GIÁ TRỊ CỦA BETA HCG TỰ DO VÀ HCG TOÀN PHẦN HUYẾT THANH TRONG BỆNH NGUYÊN BÀO NUÔI LUẬN ÁN TIẾN SĨ Y HỌC HÀ NỘI - 2022 ho tro tai file : luanvanchat@gmail.com BỘ GIÁO DỤC VÀ ĐÀO TẠO BỘ Y TẾ TRƯỜNG ĐẠI HỌC Y HÀ NỘI MAI TRỌNG DŨNG NGHIÊN CỨU GIÁ TRỊ CỦA BETA HCG TỰ DO VÀ HCG TOÀN PHẦN HUYẾT THANH TRONG BỆNH NGUYÊN BÀO NUÔI Chuyên ngành : Sản Phụ khoa Mã số : 9720105 LUẬN ÁN TIẾN SĨ Y HỌC Người hướng dẫn khoa học: PGS.TS Phạm Huy Hiền Hào HÀ NỘI - 2022 ho tro tai file : luanvanchat@gmail.com LỜI CAM ĐOAN Tơi Mai Trọng Dũng, nghiên cứu sinh khóa 35, Trường Đại học Y Hà Nội, chuyên ngành Sản Phụ khoa xin cam đoan: Đây luận án thân trực tiếp thực hướng dẫn Thầy: PGS.TS Phạm Huy Hiền Hào Cơng trình khơng trùng lặp với nghiên cứu khác công bố Việt Nam Các số liệu thông tin nghiên cứu hồn tồn xác, trung thực khách quan, xác nhận chấp thuận sở nơi nghiên cứu Tơi xin hồn tồn chịu trách nhiệm trước pháp luật cam kết Hà Nội, ngày tháng năm 2022 Người viết cam đoan Mai Trọng Dũng ho tro tai file : luanvanchat@gmail.com DANH MỤC CÁC CHỮ VIẾT TẮT αhCG Alpha Human Chorionic Gonadotropin hCG Beta Human Chorionic Gonadotropin AUC Diện tích đường cong (Area Under the Curve) CDKN1C Cyclin-dependent kinase inhibitor 1C CIA Chemiluminescent Immuno Assay CRP C – reactive protein CT Chửa trứng CTBP Chửa trứng bán phần CTHT Chửa trứng hoàn toàn CTXN Chửa trứng xâm nhập E2 Estradiol ECL Electrode Chemi Luminescence EIA Enzyme immunoassays ELISA Enzyme-linked Immunosorbent assay FIGO International Federation of Gynecology and Obstetrics FRHM Familial Recurrent Hydatidiform Moles FSH Follicle Stimulating Hormone GPH Glycoprotein Hormone Hb Haemoglobin HCG Human Chorionic Gonadotropin HCG-H Human Chorionic Gonadotropin Hyperglycosylated HPL Human Placental Lactogen IA Immunofluorescence assays IPL Imprinted in placenta and liver IS International Standard ho tro tai file : luanvanchat@gmail.com ISOBM International Society of Oncology and Biomarkers ITA Invasive trophoblast antigen IU International Unit KHDC3L KH Domain Containing Like LH Hormone Luteinizing Max Giá trị lớn Min Giá trị nhỏ mMoM Mean multiple of the median NLRP7 NACHT, LRR and PYD domains-containing protein PIGF Placenta growth factor PLAP Placental alkaline phosphatase RIA Radioimmunoassay ROC Receiver Operating Characteristic sFlt1 Soluble fms-like tyrosine kinase-1 T4 Thyroxine TGFβ Transforming growth factor beta TSH Thyroid-stimulating hormone UNBN U nguyên bào nuôi VEGF Vascular endothelial growth factor WHO World Health Organization ± SD Trung bình ± Độ lệch chuẩn (Mean ± Standard Deviation) ho tro tai file : luanvanchat@gmail.com MỤC LỤC LỜI CAM ĐOAN DANH MỤC CÁC CHỮ VIẾT TẮT MỤC LỤC DANH MỤC BẢNG DANH MỤC BIỂU ĐỒ DANH MỤC HÌNH ĐẶT VẤN ĐỀ CHƯƠNG 1: TỔNG QUAN TÀI LIỆU 1.1 Tổng quan bệnh nguyên bào nuôi 1.1.1 Phân loại mô bệnh học bệnh nguyên bào nuôi 1.1.2 Tính chất di truyền bệnh nguyên bào nuôi 1.1.3 Chẩn đốn bệnh ngun bào ni 10 1.1.4 Điều trị bệnh nguyên bào nuôi 12 1.1.5 Theo dõi sau điều trị 14 1.2 Đặc điểm cấu trúc chức sinh học hCG 15 1.2.1 Cấu trúc phân tử hCG 16 1.2.2 Chuyển hóa hCG 19 1.3 Chức sinh học hCG thai nghén 20 1.3.1 Chức sinh học phân tử hCG thông thường 21 1.3.2 Chức sinh học hCG-H 22 1.3.3 Chức sinh học βhCG tự 23 1.3.4 Chức sinh học hCG tuyến yên 24 1.4 Các phương pháp xét nghiệm hCG 25 1.4.1 Xét nghiệm hCG phương pháp sinh vật 25 1.4.2 Xét nghiệm hCG phương pháp miễn dịch 25 1.4.3 Tính đặc hiệu ứng dụng phương pháp xét nghiệm 30 1.5 Các vấn đề tồn chẩn đốn tiên lượng bệnh ngun bào ni kết số nghiên cứu liên quan đến βhCG tự do, hCG toàn phần huyết 32 ho tro tai file : luanvanchat@gmail.com Chương 2: ĐỐI TƯỢNG VÀ PHƯƠNG PHÁP NGHIÊN CỨU 35 2.1 Đối tượng nghiên cứu 35 2.1.1 Tiêu chuẩn lựa chọn 35 2.1.2 Tiêu chuẩn loại trừ 36 2.1.3 Tiêu chuẩn chẩn đoán u nguyên bào nuôi sau chửa trứng 37 2.1.4 Tiêu chuẩn khỏi bệnh theo dõi sau nạo trứng 37 2.2 Phương pháp nghiên cứu 37 2.2.1 Thiết kế nghiên cứu 37 2.2.2 Cỡ mẫu nghiên cứu 37 2.2.3 Phương pháp tiến hành nghiên cứu 39 2.2.4 Thu thập thông tin cho nghiên cứu 42 2.2.5 Xét nghiệm βhCG tự hCG nguyên vẹn huyết 44 2.2.6 Tính nồng độ hCG tồn phần tỷ lệ βhCG tự do/hCG toàn phần huyết 46 2.3 Phương pháp phân tích xử lý số liệu 46 2.4 Vấn đề đạo đức nghiên cứu 47 Chương 3: KẾT QUẢ NGHIÊN CỨU 48 3.1 Một số đặc điểm nhóm nghiên cứu 48 3.1.1 Một số đặc điểm nhóm chửa trứng 48 3.1.2 Đặc điểm nhóm đối chứng 59 3.2 Kết mục tiêu 60 3.2.1 Giá trị loại hCG huyết chửa trứng 61 3.2.2 Giá trị loại hCG huyết chửa thường 62 3.2.3 Giá trị loại hCG huyết u nguyên bào nuôi 62 3.2.4 So sánh giá trị hCG huyết nhóm 63 3.3 Kết mục tiêu 76 CHƯƠNG 4: BÀN LUẬN 79 4.1 Bàn luận số đặc điểm nhóm nghiên cứu 79 4.1.1 Bàn luận số đặc điểm nhóm chửa trứng 79 4.1.2 Đặc điểm nhóm đối chứng 97 4.2 Bàn luận mục tiêu nghiên cứu 98 ho tro tai file : luanvanchat@gmail.com 4.2.1 Giá trị loại hCG huyết chửa trứng 98 4.2.2 Giá trị loại hCG huyết chửa thường 103 4.2.3 Giá trị loại hCG huyết u nguyên bào nuôi 105 4.2.4 Bàn luận vai trò βhCG tự do, hCG nguyên vẹn, hCG toàn phần tỷ lệ βhCG tự do/hCG tồn phần huyết chẩn đốn phân biệt chửa trứng, chửa thường, u nguyên bào nuôi 109 4.3 Bàn luận mục tiêu 127 KẾT LUẬN 136 KIẾN NGHỊ 138 CÁC BÀI BÁO CÓ LIÊN QUAN ĐẾN NỘI DUNG LUẬN ÁN TÀI LIỆU THAM KHẢO PHỤ LỤC ho tro tai file : luanvanchat@gmail.com DANH MỤC BẢNG Bảng 1.1 Bảng 3.1 Bảng 3.2 Bảng 3.3 Bảng 3.4 Bảng 3.5 Bảng 3.6 Bảng 3.7 Bảng 3.8 Bảng 3.9 Bảng 3.10 Bảng 3.11 Bảng 3.12 Bảng 3.13 Bảng 3.14 Bảng 3.15 Bảng 3.16 Bảng 3.17 Bảng 3.18 Bảng 3.19 Bảng 3.20 Bảng 3.21 Bảng 3.22 Bảng 3.23 Bảng 3.24 Bảng 4.1 Chẩn đoán UNBN dựa vào giới hạn tối đa nồng độ βhCG huyết hàng tuần nghiên cứu Phạm Huy Hiền Hào 2004 13 Đặc điểm nhóm tuổi loại chửa trứng 49 Đặc điểm tuổi thai chẩn đoán chửa trứng 50 Một số đặc điểm lâm sàng chẩn đoán chửa trứng 51 Đặc điểm nồng độ Hb với loại chửa trứng 52 Kết βhCG huyết chẩn đoán chửa trứng 53 Phương pháp loại bỏ chửa trứng 54 Tỷ lệ biến chứng u nguyên bào nuôi chửa trứng 54 Một số yếu tố lâm sàng có liên quan đến biến chứng u nguyên bào nuôi 56 Liên quan nồng độ Hb biến chứng u nguyên bào nuôi 57 Liên quan βhCG huyết biến chứng u nguyên bào nuôi 58 Các đặc điểm nhóm thai thường 59 Các đặc điểm nhóm u ngun bào ni đối chứng 59 Nguồn gốc xuất phát phương pháp chẩn đốn u ngun bào ni nhóm đối chứng 60 Giá trị loại hCG huyết chửa trứng 61 Giá trị loại hCG huyết chửa thường 62 Giá trị loại hCG huyết u nguyên bào nuôi 62 So sánh giá trị hCG huyết chửa trứng hoàn toàn chửa trứng bán phần 63 So sánh giá trị trung bình hCG huyết chửa trứng với chửa thường 65 So sánh giá trị trung vị hCG chửa trứng với chửa thường 66 So sánh tỷ lệ βhCG tự do/hCG toàn phần huyết chửa trứng hoàn tồn u ngun bào ni 71 So sánh tỷ lệ βhCG tự do/hCG toàn phần huyết chửa trứng bán phần u nguyên bào nuôi 72 So sánh tỷ lệ βhCG tự do/hCG toàn phần huyết chửa trứng chung u nguyên bào nuôi 73 So sánh tỷ lệ βhCG tự do/hCG toàn phần huyết chửa thường u nguyên bào nuôi 74 Liên quan giá trị hCG với biến chứng u nguyên bào nuôi 76 Giá trị tỷ lệ phần hCG huyết theo nghiên cứu Cole năm 2009 104 ho tro tai file : luanvanchat@gmail.com DANH MỤC BIỂU ĐỒ Biểu đồ 3.1 Biểu đồ 3.2 Biểu đồ 3.3 Biểu đồ 3.4 Phân loại chửa trứng hoàn toàn bán phần 48 Thời gian nồng độ βhCG âm tính theo loại chửa trứng 55 Thời gian xuất u nguyên bào nuôi 55 Biểu diễn đường cong ROC giá trị hCG huyết chẩn đoán phân biệt chửa trứng hoàn toàn chửa trứng bán phần 64 Biểu đồ 3.5 Biểu diễn đường cong ROC giá trị hCG huyết chẩn đoán phân biệt chửa trứng hoàn toàn chửa thường 67 Biểu đồ 3.6 Biểu diễn đường cong ROC giá trị hCG huyết chẩn đoán phân biệt chửa trứng bán phần chửa thường 68 Biểu đồ 3.7 Biểu diễn đường cong ROC giá trị hCG huyết chửa trứng chung chửa thường 69 Biểu đồ 3.8 Biểu diễn đường cong ROC tỷ lệ βhCG tự do/hCG tồn phần huyết chẩn đốn phân biệt CTHT UNBN 71 Biểu đồ 3.9 Biểu diễn đường cong ROC tỷ lệ βhCG tự do/hCG tồn phần huyết chẩn đốn phân biệt CTBP UNBN 72 Biểu đồ 3.10 Biểu diễn đường cong ROC tỷ lệ βhCG tự do/hCG tồn phần huyết chẩn đốn phân biệt chửa trứng u nguyên bào nuôi 73 Biểu đồ 3.11 Biểu diễn đường cong ROC tỷ lệ βhCG tự do/hCG tồn phần huyết chẩn đốn phân biệt chửa thường u nguyên bào nuôi 75 Biểu đồ 3.12 Biểu diễn đường cong ROC giá trị hCG huyết chửa trứng có biến chứng khơng có biến chứng 77 ho tro tai file : luanvanchat@gmail.com 59 60 61 62 63 64 65 66 67 68 69 Cole LA Hyperglycosylated hCG Placenta 2007;28(10):977-986 Sturgeon CM, McAllister EJ Analysis of hCG: clinical applications and assay requirements Annals of clinical biochemistry 1998;35(4):460-491 Stenman UH, Tiitinen A, Alfthan H, et al The classification, functions and clinical use of different isoforms of HCG Hum Reprod Update 2006;12(6):769-784 Cole LA Immunoassay of human chorionic gonadotropin, its free subunits, and metabolites Review Clinical chemistry 1997;43(12):2233–2243 Korhonen J, Alfthan H, Ylöstalo P, et al Disappearance of human chorionic 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Bagshawe KD Choriocarcinoma: A model for tumour markers Acta Oncologica 2009;31(1):99-106 Gaspard UJ, Reuter AM, Deville JL, et al Serum concentration of human chorionic gonadotropin and its alpha and beta subunits Trophoblastic tumours Clinical endocrinology 1980;13(4):319-329 Vartiainen J, Alfthan H, Lehtovirta P, et al Elevated hCG and a high proportion of hCGbeta in serum preceding the diagnosis of trophoblastic disease by seven months Bjog 2002;109(5):589-590 Khosravirad A, Zayeri F, Baghestani AR, et al Predictive Power of Human Chorionic Gonadotropin in Post-Molar Gestational Trophoblastic Neoplasia: A Longitudinal Roc Analysis International Journal of Cancer Management 2017;10(9) doi:10.5812/ijcm.9015 Mai Trọng Dũng Nhận xét chẩn đoán chửa trứng Bệnh viện Phụ Sản Trung ương năm 2017 Tạp chí Phụ sản 2018;16(01):127-131 ho tro tai file : luanvanchat@gmail.com 90 91 92 93 94 95 96 97 98 99 Mai Trọng Dũng Khảo sát giá trị beta hCG tự hCG toàn phần huyết bệnh lý chửa trứng Tạp chí Phụ Sản 2019;16(03):62-67 Mai Trọng Dũng, Phạm Huy Hiền Hào Vai trị loại hCG huyết chẩn đốn phân biệt chửa trứng hoàn toàn chửa trứng bán phần Tạp chí Y học Việt Nam 2020;497(1):252-257 Mai Trọng Dũng, Phạm Huy Hiền Hào Vai trò loại hCG huyết tiên lượng biến chứng u nguyên bào ni từ chửa trứng Tạp chí Y Dược học 2020;7:116-122 Mai Trọng Dũng, Phạm Huy Hiền Hào Giá trị beta hCG tự huyết chửa trứng, chửa thường u ngun bào ni Tạp chí Nghiên cứu Y học 2021;1:198-206 Mangili G, Giorgione V, Gentile C, et al Hydatidiform mole: agerelated clinical presentation and high rate of severe complications in older women Acta Obstet Gynecol Scand 2014;93(5):503-507 Usui H, Qu J, Sato A, et al Gestational Trophoblastic Neoplasia From Genetically Confirmed Hydatidiform Moles: Prospective Observational Cohort Study Int J Gynecol Cancer 2018;28(9):1772-1780 Cowans NJ, Suonpaa M, Kouru H, et al Evaluation of a dried blood spot assay to measure prenatal screening markers pregnancy-associated plasma protein a and free beta-subunit of human chorionic gonadotropin Clinical chemistry 2013;59(6):968-975 Stenman UH Standardization of assays for human chorionic gonadotropin Clinical chemistry 2004;50(5):798-800 Dương Thị Cương Gestational trophoblastic disease in Vietnam prevalence, clinical features, management Int J Gynaecol Obstet 1998;60(1):131 Nguyễn Quốc Tuấn Nghiên cứu số đặc điểm thường gặp bệnh nhân chửa trứng yếu tố liên quan đến biến chứng Luận án Tiến sĩ Y học Trường Đại học Y Hà Nội, Hà Nội 2003 ho tro tai file : luanvanchat@gmail.com 100 Nguyễn Văn Thắng Thực trạng bệnh u nguyên bào nuôi Bệnh viện Phụ Sản Trung ương hiệu giải pháp quản lý bệnh nhân cộng đồng Luận án Tiến sĩ Y học Học viện Quân Y, Hà Nội 2020 101 Lelic M, Fatusic Z, Iljazovic E, et al Challenges in the Routine Praxis Diagnosis of Hydatidiform Mole: a Tertiary Health Center Experience Med Arch 2017;71(4):256-260 102 Eagles N, Sebire NJ, Short D, et al Risk of recurrent molar pregnancies following complete and partial hydatidiform moles Human reproduction (Oxford, England) 2015;30(9):2055-2063 103 Soto-Wright V, Bernstein M, Goldstein DP, et al The changing clinical presentation of complete molar pregnancy Obstetrics & Gynecology 1995;86(5):775-779 104 Wolfberg AJ, Berkowitz RS, Goldstein DP, et al Postevacuation hCG levels and risk of gestational trophoblastic neoplasia in women with complete molar pregnancy Obstetrics and gynecology 2005;106(3):548-552 105 Mulisya O, Roberts DJ, Sengupta ES, et al Prevalence and Factors Associated with Hydatidiform Mole among Patients Undergoing Uterine Evacuation at Mbarara Regional Referral Hospital Obstet Gynecol Int 2018;9561413 doi:10.1155/2018/9561413 106 Al-Talib AA Clinical presentation and treatment outcome of molar pregnancy: Ten years experience at a Tertiary Care Hospital in Dammam, Saudi Arabia J Family Community Med 2016;23(3):161-165 107 Joneborg U, Marions L Current Clinical Features of Complete and Partial Hydatidiform Mole in Sweden The 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reliable marker of placental site trophoblastic tumors Gynecol Oncol 2006;102(2):160-164 ho tro tai file : luanvanchat@gmail.com 158 Fowler DJ, Lindsay I, Seckl MJ, et al Routine pre-evacuation ultrasound diagnosis of hydatidiform mole: experience of more than 1000 cases from a regional referral center Ultrasound Obstet Gynecol 2006;27(1):56-60 159 Sebire NJ, Rees H, Paradinas F, et al The diagnostic implications of routine ultrasound examination in histologically confirmed early molar pregnancies Ultrasound Obstet Gynecol 2001;18(6):662-665 160 Kimiaee P, Ashrafi-vand S, Mansournia MA, et al Predictive values of different forms of human chorionic gonadotropin in postmolar gestational trophoblastic neoplasia Int J Gynecol Cancer 2014;24(9):1715-1722 161 Vetter V Management of gestational trophoblastic disease JAAPA : official journal of the American Academy of Physician Assistants 2013;26(3):31-35 162 Lybol C, Sweep FC, Ottevanger PB, et al Linear regression of postevacuation serum human chorionic gonadotropin concentrations predicts postmolar gestational trophoblastic neoplasia Int J Gynecol Cancer 2013;23(6):1150-1156 163 Hotakainen K, Ljungberg B, Paju A, et al The free beta-subunit of human chorionic gonadotropin as a prognostic factor in renal cell carcinoma British journal of cancer 2002;86(2):185-189 164 Li J, Yin M, Song W, et al B Subunit of Human Chorionic Gonadotropin Promotes Tumor Invasion and Predicts Poor Prognosis of Early-Stage Colorectal Cancer Cell Physiol Biochem 2018;45(1):237-249 165 Lempiainen A, Stenman UH, Blomqvist C, et al Free beta-subunit of human chorionic gonadotropin in serum is a diagnostically sensitive marker of seminomatous testicular cancer Clinical chemistry 2008;54(11):1840-1843 ho tro tai file : luanvanchat@gmail.com 166 Froeling FEM, Ramaswami R, Papanastasopoulos P, et al Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours British journal of cancer Feb 22 2019;doi:10.1038/s41416-019-0402-0 167 Khazaeli MB, Hedayat MM, Hatch KD, et al Radioimmunoassay of free beta-subunit of human chorionic gonadotropin as a prognostic test for persistent trophoblastic disease in molar pregnancy Am J Obstet Gynecol 1986;155(2):320-324 ho tro tai file : luanvanchat@gmail.com Phụ lục PHỤ LỤC 1.Chuyển đổi đơn vị kết βhCG tự do, hCG nguyên vẹn huyết chửa trứng (n = 191) Giá trị βhCG tự huyết Loại hCG X ± SD (Min - Max) Trung vị (Tứ phân vị) βhCG tự (ng/ml) βhCG tự (nmol/l) βhCG tự (ng/ml) βhCG tự (nmol/l) 529,4 ± 472,3 22,6 ± 20,1 362 15,4 (21,1 – 1991,1) (0,9 – 84,8) (55,9 – 1758,3) (2,4 – 74,9) CTBP 174,0 ± 183,4 (2,6 – 918) 7,4 ± 7,8 (0,1 – 39,1) 122,1 (12,1 – 678,7) 5,2 (0,5 – 28,9) Chửa trứng chung 432,6 ± 443,0 (2,6 – 1991,1) 18,4 ± 18,9 (0,1 – 84,8) 294,1 (24,6 – 1580,6) 12,5 (1,0 – 67,3) Loại chửa trứng CTHT Giá trị hCG nguyên vẹn huyết Loại hCG X ± SD Trung vị (Min - Max) (Tứ phân vị) Loại chửa trứng HCG nguyên vẹn (IU/L) CTHT 260.974 ± 241.073 (13.526 - 1.430.298) 750,1 ± 692,9 175.209 (38,9 - 4110,8) (34.553 – 774.627) 503,6 (99,3 – 2226,3) CTBP 127.543 ± 116.910 (1392 - 92.589) 366,6 ± 336,0 (4,0 - 1703,1) 107.492 (11.760 – 435.516) 308,9 (33,8 – 1251,7) Chửa trứng chung 224.647 ± 222.319 (1392 - 1.430.298) 645,7 ± 639,0 (4,0 - 4110,8) 148.239 (19.384 – 709.213) 426,0 (55,7 – 2038,3) HCG nguyên vẹn (nmol/l) HCG nguyên vẹn (IU/L) ho tro tai file : luanvanchat@gmail.com HCG nguyên vẹn (nmol/l) Phụ lục PHỤ LỤC Chuyển đổi đơn vị kết βhCG tự do, hCG nguyên vẹn huyết nhóm đối chứng 2.1 Giá trị hCG huyết chửa thường (n=86) Giá trị βhCG tự huyết X ± SD Trung vị (Min – Max) (Tứ phân vị) βhCG tự (ng/ml) 71,2 ± 47,6 (8,7 - 270,6) βhCG tự βhCG tự βhCG tự (nmol/l) (ng/ml) (nmol/l) 3,0 ± 2,0 58,0 2,5 (0,4 – 11,5) (23,0 – 183,4) (1,0 – 7,8) Giá trị hCG nguyên vẹn huyết X ± SD Trung vị (Min - Max) (Tứ phân vị) HCG nguyên vẹn HCG nguyên vẹn HCG nguyên vẹn HCG nguyên vẹn (IU/L) (nmol/l) (IU/L) (nmol/l) 103.930 ± 46.601 298,7 ± 133,9 97.644 280,6 (20.404 - 259.960) (58,6 – 747,1) (41.354 - 202.917) (118,9 – 583,2) 2.2 Giá trị βhCG tự huyết nhóm u ngun bào ni (n=33) Giá trị βhCG tự huyết X ± SD (Min - Max) Trung vị (Tứ phân vị) βhCG tự (ng/ml) 121,7 ± 154,7 (0,14 – 508,0) βhCG tự βhCG tự βhCG tự (nmol/l) (ng/ml) (nmol/l) 5,2 ± 6,6 53,1 2,3 (0,01 – 21,6) (0,2 – 494,0) (0,01 – 21,04) Giá trị hCG nguyên vẹn huyết X ± SD Trung vị (Min - Max) (Tứ phân vị) HCG nguyên vẹn HCG nguyên vẹn HCG nguyên vẹn HCG nguyên vẹn (IU/L) (nmol/l) (IU/L) (nmol/l) 47.403 ± 89.489 (10,6 – 390.030) 136,2 ± 257,2 (0,03 – 1121,0) 8.328 (65 – 321.122) 23,9 (0,2 – 922,9) ho tro tai file : luanvanchat@gmail.com Savage PM, Sita-Lumsden Dickson S, et al The relationship of maternal age to molar pregnancy incidence, risks for chemotherapy and subsequent pregnancy outcome JA, Obstet Gynaecol May 2013;33(4):406-11 doi:10.3109/01443615.2013.771159 Hào PHH trò beta hCG huyết theo dõi sauTD-7 nạo trứng, điều trị uYVai nguyên bào nuôi 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beta-subunit of human chorionic gonadotropin asBritish aprognostic prognostic test for persistent trophoblastic disease inHatch molar pregnancy Am J etObstet Aug 1986;155(2):320-4 TÀI LIỆU THAM KHẢO ENDNOTE (KHÔNG IN) ho tro tai file : luanvanchat@gmail.com ... nguyên vẹn, hCG toàn phần tỷ lệ ? ?hCG tự do /hCG tồn phần huyết bệnh ngun bào ni, chửa thường Xác định giá trị ? ?hCG tự do, hCG nguyên vẹn, hCG toàn phần tỷ lệ ? ?hCG tự do /hCG toàn phần huyết tiên lượng... hCG nguyên vẹn sau tính tốn giá trị hCG tồn phần tỷ lệ ? ?hCG tự do /hCG toàn phần huyết Mục tiêu nhóm nghiên cứu là: - Xác định trị số ? ?hCG tự do, hCG nguyên vẹn, hCG toàn phần tỷ lệ ? ?hCG tự do /hCG. .. phần huyết chửa trứng bán phần u nguyên bào nuôi 72 So sánh tỷ lệ ? ?hCG tự do /hCG toàn phần huyết chửa trứng chung u nguyên bào nuôi 73 So sánh tỷ lệ ? ?hCG tự do /hCG toàn phần huyết