甲氨蝶呤单剂量肌内注射治疗异位妊娠的临床研究  

Therapeutic Effect of Single-dose Methotrexate for Ectopic Pregnancy

作　　者：黄丽[1] 洛若愚[2] 龚豪[1] 张蔚[2] 梁华[2] 

机构地区：[1]武汉大学第一临床学院,430060 [2]武汉大学人民医院妇科

出　　处：《国际妇产科学杂志》2012年第1期84-87,共4页Journal of International Obstetrics and Gynecology

摘　　要：目的 :探讨影响甲氨蝶呤(methotrexate,MTX)单剂量肌内注射(肌注)治疗异位妊娠(ectopic preg-nancy,EP)疗效的相关因素。方法:回顾性分析武汉大学人民医院2006年7月—2011年7月行MTX单剂量肌注治疗的EP患者临床资料。结果:纳入269例EP患者,根据最终结局分为失败组和成功组,失败组52例(19.3%),成功组217例(80.7%)。失败组的初始血人绒毛膜促性腺激素β亚单位(β-hCG)浓度、EP史比例、妊娠周、包块直径高于成功组(P<0.05)。多因素Logistic回归分析提示,初始β-hCG为2 000～5 000 IU/L及≥5 000 IU/L,妊娠周为6～8周及>8周、超声包块直径≥4 cm是MTX单剂量肌注治疗失败的危险因素。患者年龄、妊娠次数、人工流产史、盆腔手术史、节育器使用史与治疗失败率无关(P>0.05)。受试者工作特征(receiver operating characteristic,ROC)曲线选择1 871.5 IU/L为初始β-hCG预测治疗成功的阈值,敏感度为82.7%,特异度为70%,曲线下面积为0.8(P<0.05)。结论 :初始β-hCG浓度高、妊娠时间长、包块直径大是MTX单剂量肌注治疗失败的危险因素,须谨慎行MTX单剂量肌注方案,治疗期间应密切观察。Objective：To determine the risk factors for failture of an ectopic pregnancy（EP）with single-dose methotrexate.Methods：The clinical data of patients after a single-dose methotrexate for EP in Renmin Hospital of Wuhan University from July 2006 to July 2011 was reviewed retrospectively.Results：Two hundred and sixty-nine cases of EP were reviewed.The cases were divided into twogroups.One group（19.3%） were cases with ruptured EP and another group were 144（80.7%） cases with unruptured EP.failure group and successful group according to the outcome.Fifty-two of them The mean level of pretreatment β-hCG,ratio of previous EP,mean gestation（in weeks）,and size of the gestational mass were significantly higher in patients with ruptured EP compared with patients with unruptured EP（P〈0.05）.Logistic regression analysis revealed that 2 000～5 000 IU/L of pre-hCG level and≥5 000 IU/L of pre-hCG levels and also 6～8 weeks of amenorrhoea and 8 weeks of amenorrhoea and size of the gestational mass≥4 cm were the significantly risk factors for tubal rupture（P〈0.05）.No significantly associations existed regarding age,previous normal deliveries,previous induced abortion,prior pelvic surgery and use of an intra-uterine contraceptive device（IUD）.The receiver operating characteristic（ROC） curve cutoff value in the success group indicated an initialβ-hCG level of 1 871.5IU/L.At the value of 1 871.5 IU/L,sensitivity and specificity in the success group reached 82.7% and 70%.The area under the curve reached 0.8（P〈0.05）.Conclusions：Higher initial β-hCG level,higher gestational age and size of the gestational mass seem to be significant risk factors for failure of single-dose methotrexate therapy,Methotrexate should be used with caution in patients with EP.

关 键 词：妊娠 异位 甲氨蝶呤 危险因素 LOGISTIC模型 ROC曲线 

分 类 号：R714.22[医药卫生—妇产科学]