孕酮及抑制素A水平对异位妊娠患者药物疗效的预测作用  

The predictive value of pretherapeutic serum progesterone and inhibin-A concentrations to the drug-curative effect of the patients with ectopic pregnancy

作　　者：余锦芬[1] 林虹[1] 代红波 陈红[2] 

机构地区：[1]湖北省十堰市妇幼保健院妇科,湖北十堰442000 [2]武汉大学中南医院妇产科,湖北武汉430062

出　　处：《中国医药导报》2014年第1期79-82,共4页China Medical Herald

摘　　要：目的探讨治疗前血清孕酮及抑制素A（INH—A）对异位妊娠（EP）患者药物保守治疗效果的预测作用。方法选择2011年1月～2012年6月湖北省十堰市妇幼保健院妇科接受药物保守治疗的EP患者52例。所有患者均给予单次肌内注射甲氨蝶呤（MTX）（50mg／m^2）及口服米非司酮（50mg，2次／d）3d治疗。对患者治疗前及治疗后血清β-绒毛膜促性腺激素（β—HCG）、孕酮及INH—A水平进行监测。根据患者治疗后血清β～HCG水平能否降至25U／L以下，将患者分为有效组（血清β—HCG≤25U／L）和无效组（血清β—HCG〉25U／L），比较两组患者治疗前血清孕酮及INH—A水平，并采用受试者工作特性曲线（ROC曲线）评价治疗前血清孕酮和INH—A水平对EP患者药物保守治疗效果的预测作用，同时比较有效组患者血清β—HCG、孕酮及INH—A水平降至正常值的时间。结果有效组和无效组患者分别为39例和13例，药物保守治疗有效率为75．00％。有效组患者治疗前血清孕酮水平[（35.79±11．84）nmol／L比（52．54±14．49）nmol／L]和INH—A值[（148．16±36．90）ng／L比（205．19±59．68）ng／L]均明显低于无效组患者（均P〈0．05）；ROC曲线结果显示单独采用治疗前血清孕酮或INH—A水平预测药物保守治疗效果的ROC曲线下面积分别为0．821（95％CI：0．784～0．877，P〈0．01）和0．781（95％CI：0．741～0．829，P〈0．01），而联合两者时ROC曲线下面积为0．909（95％CI：0．863～0．947，P〈0．01）；有效组患者血清孕酮[（13．78±5．29）d1及INH—A[（4．21±1．56）d]降至正常值以下的时间均明显短于血清β—HCG水平[（25．76±5．75）d]降至正常值以下的时间（均P〈0．05），但血清INH—A水平在降至正常值后存在再次升高的现象，而血清孕酮水平未出现这种情况。结论治疗前血清孕酮和INH—A水平均可作为EP患者药物保�Objective To explore the predictive value of pretherapeutic serum progesterone and inhibin-A （INH-A） concentrations to the drug-curative effect of the patients with ectopic pregnancy （EP）. Methods 52 patients with EP, hospitalized in the Department of Gynaecology in Shiyan Maternal and Child Health Hospital from January 2011 to June 2012, who were given the drug treatment （single-dose intramuscular injection with 50 mg/m2 Methotrexate and peros Mifepristone 50 mg bid for 3 days）. Before and after drug treatment, to all the patients, the serum β-human chorionie gonadonophin （β-HCG）, progesterone and INH-A concentrations were monitored. According to the curative effect, the patients were divided into the effective group and the no-effective group. The pretherapeutic serum progesterone and INH-A concentrations were compared between the two groups. Moreover, the receiver-operator curves （ROC） were used to determine the predictive value of pretherapeutic serum progesterone and INH-A concentrations to the drug-curative effect. In the effective group, the time which the serum β-HCG, progesterone and INH-A reduced to below the normal level were also compared. Results There were 39 and 13 patients in the effective group and no-effective group respec- tively, the effective rate of drug treatment was 75.00%; compared to the no-effective group, the pretherapeutic serum progesterone [（35.79±11.84） nmol/L vs （52.54±14.49） nmol/L] and INH-A [（148.16±36.90） ng/L vs （205.19±59.68） ng/L] concentrations were both lower in the effective group （P 〈 0.05）; the power of pretherapeutic serum progesterone and INH-A concentration to alone predict the drug-curative effect were examined by ROC curves, the area under the curve was 0.821 （95%CI： 0.784-0.877, P 〈 0.01） and 0.781 （95%CI： 0.741-0.829, P 〈 0.01） respectively; when combine the pretherapeutic serum progesterone and INH-A concentration to predict, the curve was 0.909 （95%CI： 0.863-0.947, P 〈 0.01）; in the effec

关 键 词：异位妊娠 孕酮 抑制素A 药物治疗 治疗效果 

分 类 号：R714.22[医药卫生—妇产科学]