甲氨蝶呤治疗异位妊娠的疗效及其影响因素分析  

Analysis of efficacy of methotrexate on ectopic pregnancies and its prognostic factors

作　　者：曾凡湘[1] 史道华[1] 邓婕[1] 刘颖[1] 郑翠仙[2] 黄丽燕[1] 

机构地区：[1]福建省妇幼保健院/福建医科大学教学医院药剂科,福州350001 [2]福建省妇幼保健院/福建医科大学教学医院妇产科,福州350001

出　　处：《中国临床药理学杂志》2015年第5期348-350,共3页The Chinese Journal of Clinical Pharmacology

基　　金：福建省临床重点专科建设项目资助(闽卫科教[2012]149号);福建省卫生厅青年科研课题资助项目(2013-2-12)

摘　　要：目的分析甲氨蝶呤(MTX)治疗异位妊娠(EP)的临床疗效,并建立其特征指标治疗前血清人绒毛膜促性腺激素(h CG)的临界值。方法入选2010年4月至2012年3月福建省妇幼保健院用MTX治疗的异位妊娠患者150例为研究对象,分为2组。试验组(n=78)用1 mg·kg-1MTX分3次间隔48 h肌内注射;对照组(n=72)用1 mg·kg-1MTX,单次肌内注射;2组均根据血清h CG下降幅度,必要时可再给MTX。比较MTX不同给药方案的临床疗效及不良反应发生率,并分析血清h CG等因素对MTX近期疗效的影响。结果 2组的临床疗效比较差异无统计学意义(P>0.05)。试验组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。试验组治疗前血清h CG最佳工作点为1495.49 m IU·m L-1。结论 MTX多次给药方案的临床疗效与单剂方案相当,但不良反应发生率较低;治疗前血清h CG≤1500 m IU·m L-1可选用该方案。Abstract： Objective To evaluate the efficacy of methotrexate （MTX） on ectopic pregnancies （EP） and to define an optimal cutoff serum level of human chorionie gonadotropin （hCG）. Methods One hundred and fifty women with EP treated with MTX were involved in Fujian provincial maternal and child health care hospital from April 2010 to March 2012 and then were divided into two groups. Seventy eight cases in trial group were treated with MTX protocol （overall intramuscular dosage of 1 mg ~ kg - 1, divided into 3 times at 48 - hours intervals）, and 72 cases in control group were treated with single intramuscular injection of MTX 1 mg ~ kg-1. MTX could be repeated according to the degree of hCG. The data of clinical efficacy and safety were compared between two groups and the influence of hCG on the short - term efficacy of MTX. Results There was no significant difference of two groups in efficacy found （P 〉 0.05 ）. The incidence of adverse drug reactions in trial group was lower than those in control group （ P 〈 0. 05 ）. The receiver operating characteristic curve cutoff value was 1495.49 mIU · mL- 1 in terms of ini- tial hCG level in trial group. Conclusion The efficacy of multiple doses of MTX is similar to that of single dose, but with a lower incidence rate of adverse drug reaction. It is an alternative for patients with hCG lower than 1500 mlU · mL-1 under pre- therapy condition.

关 键 词：甲氨蝶呤 给药方案 异位妊娠 人绒毛膜促性腺激素 接受者工作特征曲线 

分 类 号：R969.4[医药卫生—药理学] R979.12[医药卫生—药学]