甲氨蝶呤治疗异位妊娠的预测指标与阈值研究  

Study on Predictive Factors and Threshold of Methotrexate Therapy for Ectopic Pregnancy

作　　者：王丽军 陈志芳[1] 李雪琴 WANG Lijun;CHEN Zhifang;LI Xueqin(Department of Obstetrics and Gynecology,the People’s Hospital of Yanling County,He’nan Province 461200)

机构地区：[1]河南省鄢陵县人民医院妇产科,461200

出　　处：《医学理论与实践》2022年第22期3802-3805,共4页The Journal of Medical Theory and Practice

摘　　要：目的:探讨甲氨蝶呤(MTX)肌肉注射治疗异位妊娠(EP)效果预测指标,分析阈值。方法:以194例采用MTX肌肉注射治疗的EP患者为研究对象,其中132例治疗成功(成功组),62例治疗失败(失败组),比较成功组与失败组一般特征、基线血清β-人绒毛膜促性腺激素(β-hCG)水平及用药后血清β-hCG变化。结果:成功组基线血清β-hCG(β-hCG_(0))显著低于失败组(P<0.05),不同组年龄、停经天数、孕次、分娩史、妊娠包块长径无显著差异(P>0.05)。成功组首次用药后4d与7d血清β-hCG显著低于失败组(P<0.05),成功组首次用药后4d血清β-hCG相对于基线的变化幅度(β-hCG_(0~4))、首次用药后7d血清β-hCG相对于用药后4d的变化幅度(β-hCG_(4~7))与失败组差异显著(P<0.05)。ROC分析结果显示β-hCG_(0)、β-hCG_(0~4)与β-hCG_(4~7)预测治疗成功率的曲线下面积(AUC)分别为0.673、0.831与0.720,cut-off值分别为3530.5IU/L、-9.4%与-16.2%。结论:MTX肌肉注射治疗无症状、血流动力学稳定的EP患者效果较好,β-hCG_(0~4)是治疗效果早期预测的理想指标。Objective:To explore the predictive factors and threshold of the effect of methotrexate(MTX)intramuscular injection therapy for ectopic pregnancy(EP).Methods:194 EP patients accepted MTX intramuscular injection therapy were selected,divided into successful treatment group(n=132)and failed treatment group(n=62).The general characteristics,baseline serumβ-human chorionic gonadotropin(beta-human chorionic gonadotropin,β-hCG)and serumβ-hCG change after medication were compared.Results:Theβ-hCG_(0) of successful treatment group was significantly lower than that of failed treatment group(P<0.05),there were no significant differences in age,amenorrhea days,parity,delivery history,and longest ectopic mass diameter between different groups(P>0.05).The serumβ-hCG in 4th and 7th day of the successful treatment group were significantly lower than those of the failure treatment group(P<0.05),there were significant differences inβ-hCG_(0~4) andβ-hCG_(4~7) successful treatment group and failed treatment group(P<0.05).ROC analysis results showed that the area under the curve(AUC)ofβ-hCG_(0),β-hCG_(0~4) andβ-hCG_(4~7) for treatment success rate predicting were 0.673,0.831 and 0.720,and the cut-off values were 3530.5IU/L,-9.4%and-16.2%,respectively.Conclusion:MTX intramuscular injection is an effective option for asymptomatic and hemodynamically stable EP patients.β-hCG_(0~4) is an ideal indicator for early prediction of treatment effect.

关 键 词：异位妊娠 甲氨蝶呤 保守治疗 效果预测 Β-人绒毛膜促性腺激素 

分 类 号：R714.22[医药卫生—妇产科学]