阴道超声检查联合血β-HCG检测在输卵管妊娠药物治疗中的作用  

The Applications of Transvaginal Sonography and Blood β-HCG Detection in the Medical Treatment of Tubal Ecotopic Pregnancy

作　　者：万晓燕[1] 狄文[1] 刘芳荪[1] 

机构地区：[1]上海交通大学医学院附属仁济医院,上海200127

出　　处：《实用妇产科杂志》2013年第10期762-765,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨阴道超声检查联合血β-HCG检测对输卵管妊娠药物治疗的指导作用。方法:回顾性分析上海交通大学医学院附属仁济医院于2010年1～12月收治的经药物治疗失败、术后确诊为输卵管妊娠的19例患者的临床资料,对其超声图像、血β-HCG水平进行分析。结果:①药物治疗前,输卵管环形(DUNUT)征6例的血β-HCG(3242±837 U/L)明显高于13例不均质等回声型(403±70 U/L)(P=0.019);不均质等回声型超声所测的最大径线值与血β-HCG值呈正相关(r=0.580,P=0.038)。②药物治疗期间,超声图像判断为持续等回声型9例(等回声体积增大>3 mm者6例);由等回声转为DUNUT征4例;由DUNUT征转为孕囊型3例;持续DUNUT征3例(2例血β-HCG值分别上升220 U/L和300 U/L)。等回声转为DUNUT征的患者治疗后第4日血β-HCG上升比率(163±23)%明显高于持续等回声型的患者(55±17)%(P=0.004)。③手术前,不均质等回声型(9例)的血β-HCG值(382±74 U/L)和DUNUT征(7例)的血β-HCG值(1752±858 U/L)明显低于孕囊型(3例)(5600±802 U/L)(P=0.023;P=0.028)。结论:不同超声图像中血β-HCG值有差异,孕囊型最高,等回声直径越大,其血β-HCG值越高。当附件区不均质等回声体积不断增大,患者血β-HCG第4日浓度明显上升,或超声图像发生质变时,均提示药物治疗效果不佳。Objective：To investigate guidance function of the combination of transvaginal sonography and blood β-HCG in the medical treatment of tubal ecotopic pregnancy. Methods：The clinical data of 19 ectopic pregnancy patients,who firstly undergone ineffectual medical therapy with MTX and finally diagnosed as ec- otopic pregnancy after surgical treatment,were retrospectively analyzed. The ultrasound image and blood lev- el of β-HCG of these patients were analyzed. Reaults：（1）Before the medical treatment,the blood level of β-HCG（3242 ±837 U/L）in DUNUT group （6 cases） was obviously higher than that （403±70 U/L）in the mixed adnexal mass group（ 13 cases） （ P = 0. 019）, the level of β-HCG was positively correlated with the biggest size of the mass in the mixed adnexal mass group （ r = 0. 580, P = 0. 038）. （2） After the medical treatment,9/13 patients remained in the mixed adnexal mass group,with the size increased 〉3 mm （n =6） ,the left 4/13 patients turned to DUNUT group,3/6 patients in DUNUT group turned into the group of tubal ring with a yolk sac with/without embryo,3/6 patients in DUNUT group were with continuous DUNUT （the level （5-HCG in two of them elevated 220 U/L and 300 U/L respectively）. The increased blood level of β-HCG （ 163 ±23） % （of the day 4 compared with the day 0 ）in the group of mixed adnexal mass turned into the DUNUT was higher than that in the remained group of the mixed adnexal mass （55 ± 17） % （ P = 0. 004）. （3）Before the surgical treatment,the β-HCG （5600 ±802 U/L） in the group of tubal ring with a yolk sac with/without embryo was obviously higher than that in the mixed adnexal mass group（382 ± 74 U/L） or DUNUT group （ 1752 ± 858 U/L） （ P = 0. 023; P = 0. 028 ）. Conclusions： The blood level of β-HCG varied over different sonography image. The increased size of mixed adnexal mass,the increased blood level of β-HCG （of the day 4 compared with the day 0）, and the changed sonography image, may be a

关 键 词：输卵管妊娠 药物治疗 阴道超声 血Β-HCG 甲氨蝶呤 

分 类 号：R714.221[医药卫生—妇产科学]