過度醣化絨毛膜促性腺激素之臨床意義及應用

Hyperglycosylated Chorionic Gonadotropin

對有持續性低絨毛膜促性腺激素的患者，通常可分為兩類型來處理，一型稱靜止性型妊娠滋養層疾病，屬不活躍或良性的滋養層疾病，患者有3個月或更長的時間低價的total hCG，但查不到hyperglycosylated hCG，此類患者不需要治療。另一型稱輕度侵犯性型妊娠滋養層疾病，有低價的total hCG，其中hyperglycosylated hCG值＜40％，但可能會漸漸上升，因其倍增時率（doubling rate）約需2-6週，可等到total hCG＞3000 IU/L時，再以化學藥方EMA-CO或EMA-EP治療，大多會成功。對少數低價total hCG，但含hyperglycosylated hCG＞40％者，可稱非靜止型高hCG滋養層疾病，則需立即以EMA-CO或EMA-EP治療，亦多會成功。

For patient with persistent low human chorionic gonadotropin (hCG), there are 2 little known subtypes of gestational trophoblastic neoplasia and how measurement of hyperglycosylated hCG can be used to diagnose and manage these rare conditions. Quiescent gestational trophoblastic disease is a new entity defined by low levels of total hCG which persists for at least 3 months with undetectable or very low levels of hyperglycosylated hCG. These patients have had documented evidence of previous gestational trophoblastic neoplasia; and, presumably, there is no clinical evidence of local or metastatic disease at this time. In the vast majority of these patients with very low levels of total hCG and undetectable hyperglycosylated hCG. The total hCG level fall to normal within 6 months with no therapy. Another group of patients were evaluated with low hCG levels and low levels of hyperglycosylated hCG. There patients were labeled minimally invasive gestational trophoblastic disease, and these patients are all chemo-resistant. Some authors have recommended a temporary hold on chemotherapy until the total serum hCG level reach 3000 IU/mL. At this point, the tumor is actively growing again and chemotherapy should be resumed.