Gökhan KARAKOÇ, Mehmet Özgür AKKURT, Burak TATAR, Mehmet Muammer DOĞAN, Yakup YALÇIN, And YAVUZ

Histopatolojik Olarak Ektopik Gebe Olduğu Kanıtlanan Hastalarda Serum Ca-125, Östradiol ve Progesteron Düzeyleri

Amaç: Serum östradiol, progesteron, E2-P oranı ve kanser antijen 125 düzeylerinin normal gebelik ve ektopik gebeliği olan hastalarda karşılaştırılarak, bu parametrelerin ektopik gebeliğin erken tanısında muhtemel etkisinin belirlenmesi amaçlanmaktadır.Gereç ve Yöntemler: Çalışma grubuna; ektopik gebelik tanısı ile opere olup histopatolojik olarak tanısı doğrulanan 100 hasta dahil edildi. Kontrol grubunda ise 6-8 haftalar arasında normal intrauterin gebeliği olan 100 kadın çalışmaya dahil edildi. Gruplar kan Ca-125, E2 ve P seviyesi açısından karşılaştırıldı. Çalışma grubundaki 10 hastaya laparatomik yaklaşım, 90 hastaya laparaskopik yaklaşım yapıldı. Ektopik gebeliklerin 30’unda rüptür saptandı. 89 hastaya salpenjektomi yapılırken, 11 hastaya salpingostomi yapıldı.Bulgular: Kontrol grubuyla karşılaştırıldığında, ektopik gebelik grubunda Ca-125, E2, P ve E2-P oranı istatiksel olarak anlamlı düşük bulunmuştur. Ektopik gebelikler kendi içinde değerlendirildiğinde rüptüre olan ve olmayan ektopik gebelerin E2-P oranı, E2, P ve Ca-125 düzeyi arasında istatistiksel olarak anlamlı bir fark bulunamadı.Sonuç: Çalışmamızda değerlendirdiğimiz E2, P, E2-P oranı ve Ca-125 ölçümü ektopik gebelik tanısında faydalı markerler olmakla birlikte ektopik gebeliğin teşhisinde tek başına yetersizdir. Yine bu parametreler ektopik gebeliğin rüptüre olup olmadığının ayrımında yetersizdir.

Anahtar Kelimeler:

CA-125 antijeni, gebelik, ektopik, östradiol, progesteron

Serum Ca-125, Estradiol And Progesterone Levels In Histopathologically Confirmed Ectopic Pregnancy Cases

Aim: To compare the serum, estradiol, progesterone, E2-P ratio and cancer antigen 125 levels between intrauterine pregnancy and ectopic pregnancy, to investigate the probable role of these markers for earlu diagnosis of ectopic pregnancy.Material and Methods: 100 patients who had diagnosis of histopathological confirmed ectopic pregnancy were defined as study group. 100 women with intrauterine, single, 6-8 weeks of gestation were defined as control group. Serum levels of CA-125, E2 and P were compared between groups. Ninety patients underwent laparoscopic surgery for ectopic pregnancy and 10 patients underwent laparatomy. Eighty-nine patients had salpingectomy and 11 of them had salpingostomy.Results: When we compared with control group, serum Ca-125, E2, P levels and E2-P ratio were lower in ectopic pregnancy group. The difference between these two groups were statistically significant. There is no statistically significant difference in E2-P ratios, E2, P and Ca-125 levels when the ectopic pregnancy group were divided into two groups as ruptured and non-ruptured.Conclusion: According to our findings, Ca-125, estradiol, progesterone levels and estradiol-progesterone ratio are useful but not satisfactory markers in the early diagnosis of ectopic pregnancy. Moreover, these parameters cannot be used in the diagnosis of rupture in ectopic pregnancy.

Keywords:

CA-125 antigen, pregnancy, ectopic, estradiol, progesterone,

PDF

___

Goldner TE, Lawson HW, Xia Z, Atrash HK. Surveillance for ectopic pregnancy-United States, 1970-1989. MMWR CDC Surveill Summ. 1993;42:73-85.
Rocha Filho EA, Santana DS, Cecatti JG, Costa ML, Haddad SM, Parpinelli MA et al. Awareness about a life-threatening condition: ectopic pregnancy in a network for surveillance of severe maternal morbidity in Brazil. Biomed Res Int. 2014:(2014):965724.
Kobayashi F, Takashima E, Sagawa N, Mori T, Fujii S. Maternal serum CA125 levels in early intrauterine and tubal pregnancies. Arch Gynecol Obstet 1993;252: 185-9.
Katsikis I, Rousso D, Farmakiotis D, Kourtis A, Diamanti-Kandarakis E, Panidis D. Receiver operator characteristics and diagnostic value of progesterone and CA-125 in the prediction of ectopic and abortive intrauterine gestations. Eur J Obstet Gynecol Reprod Biol 2006;125:226- 32.
Malatyalioglu E, Ozer S, Kokcu A, Cetinkaya MB, Alper T, Tosun M. CA-125 levels in ruptured and unruptured tubal ectopic pregnancies. J Obstet Gynaecol Res 2006;32:422-7.
Shao R, Feng Y, Zou S, Weijdegård B, Wu G, Brännström M et al. The role of estrogen in the pathophysiology of tubal ectopic pregnancy. Am J Transl Res. 2012;4:269-78.
Nilsson S, Makela S, Treuter E, Tujague M, Thomsen J, Andersson G, et al. Mechanisms of estrogen action. Physiol Rev. 2001;81:1535–65.
Shao R. Understanding the mechanisms of human tubal ectopic pregnancies: new evidence from knockout mouse models. Hum Reprod. 2010;25:584–7.
Wang H, Dey SK. Roadmap to embryo implantation: clues from mouse models. Nat Rev Genet. 2006;7:185–99.
Stovall TG, Ling FW, Carson SA, Buster JE. Serum progesteron and uterine curettage in differential diagnosis of ectopic pregnancy. Fertil Steril 1992;57:456-7.
Mc. Cord ML, Muram D, Buster JE, Arheart KL, Stoval TG, Carson SA: Single progesterone as a screen for ectopic pregnancy: exchanging specifity and sensitivity to obtain optimal test performance. Fertil Steril 1996;66:513-6.
Mol BW, Lijmer JG, Ankum WM, Van Der Veen F, Bossuyt PM. The accuracy of single serum progesterone measurment in the diagnosis of ectopic pregnancy: meta analysis. Hum. Reprod. 1998;13:3320-7.
James WH. Women’s hormone concentrations and the increasing rates of ectopic pregnancy. Hum Reprod. 1996;11:233–5.
Abdul-Hussein MM, Abdul-Rasheed OF, Al-Moayed HA. The Values of CA-125, Progesterone, ß-HCG and Estradiol in the Early Prediction of Ectopic Pregnancy. Oman Med J. 2012;27:124-8.
Y. Sadovsky, J. Pineda and J.L. Collins, Serum CA-125 levels in women with ectopic and intrauterine pregnancies, J Reprod Med 1991;36:875-8.
Schmidt T, Rein DT, Foth D, Eibach HW, Kurbacher CM, Mallmann P, et al. Prognostic value of repeated serum CA 125 measurements in first trimester pregnancy. Eur J Obstet Gynecol Reprod Biol. 2001;97:168-73.