超声引导下局部注射氨甲蝶呤治疗剖宫产瘢痕妊娠的疗效及其预测研究  

Ultrasound-guided injection of methotrexate in treatment of cesarean scar pregnancy:Outcomes and its prediction byβ-HCG

作　　者：栗嘉楠 徐虹[2] 刘勤[2] 汪龙霞[2] 李秋洋[2] LI Jia’nan;XU Hong;LIU Qin;WANG Longxia;LI Qiuyang(Chinese PLA Medical School,Beijing 100853,China;Department of Ultrasound Diagnosis,the First Medical Center,Chinse PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第一医学中心超声诊断科,北京100853

出　　处：《解放军医学院学报》2023年第11期1212-1217,1223,共7页Academic Journal of Chinese PLA Medical School

基　　金：北京市科委计划项目(Z171100001017141);军队后勤科研项目计划生育专项课题(23JSZ10)。

摘　　要：背景 剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)发病率逐年升高,但对于其治疗方案的选择缺乏共识。目的 探讨超声引导下局部注射氨甲蝶呤(methotrexate,MTX)治疗CSP的安全性、有效性和适应证,以及β-人绒毛膜促性腺激素(beta human chorionic gonadotropin,β-HCG)预测治疗结局的效能。方法 回顾性收集2008年1月-2022年12月于解放军总医院第一医学中心行超声引导下局部注射治疗的CSP患者,对比CSP患者的治疗前临床信息和影像数据,以及超声引导下局部注射MTX治疗的成功率,并行β-HCG预测效能的ROC分析。结果 研究共纳入了107例CSP患者,103例(96.26%)患者治疗成功,其中12例(11.65%)增加了MTX注射次数,余4例(3.74%)治疗失败后行手术治疗。治疗成功组的治疗前β-HCG水平显著低于失败组[Md(IQR):12 636(2 009~28 138) IU/L vs 36 678(33 076.25~147 204.3) IU/L,P=0.004]。增加MTX注射次数的患者相比一次注射的患者治疗前β-HCG水平更高[Md(IQR):9 157(1 390.8~24 888.6) IU/L vs33 260(17 048.5~80 124.5) IU/L,P=0.001]。仅1例患者出现急性肝转氨酶升高,后恢复正常。ROC分析显示,利用β-HCG预测治疗结局的ROC-AUC为0.927,利用β-HCG预测治疗次数(注射MTX的次数)的ROC-AUC为0.792。结论 超声引导下局部注射MTX治疗CSP安全有效。术后严密观察β-HCG的变化,β-HCG较低者可增加MTX注射次数或行手术治疗。Background The rate of cesarean scar pregnancy(CSP)is increasing in these years,and there is no consensus on therapy.Objective To study the safety,efficacy and indications of ultrasound-guided local injection of methotrexate(MTX)in the treatment of CSP.Methods CSP patients treated in the First Medical Center of Chinese PLA General Hospital from 2008 to 2022 were retrospectively recruited.The clinical information and imaging data of patients,as well as the success rate of ultrasound guided local injection of MTX treatment before and after treatment were compared.Then ROC analysis ofβ-HCG prediction efficiency was performed.Results Of the included 107 CSP patients,103(96.26%)patients were treated successfully,among them 12(11.65%)cases received additional MTX injection.The treatment failed in 4(3.74%)patients with surgery intervention.β-HCG in the successful group was significantly lower than that in the failed group(Md[IQR]:12636.00[2009.00-28138.00]IU/L vs 36678.00[33076.25-147204.30]IU/L,P=0.004).Patients received multiple injections of MTX had higherβ-HCG than those received single injection(Md[IQR]:9157.00[1390.80-24888.60]vs 33260.00[17048.50-80124.50],P=0.001).Only one patient had side effect and the liver transaminase elevated after therapy and improved several days later.ROC analysis showed that the AUC of treatment outcomes predicted byβ-HCG was 0.927,and the AUC of the number of treatments(MTX injections)predicted byβ-HCG was 0.792.Conclusion Ultrasound-guided injection of MTX is a safe and effective modality to treat CSP.The change trends ofβ-HCG should be monitored,additional injection of MTX or surgery intervention could be performed to patients with lowerβ-HCG if necessary.

关 键 词：剖宫产瘢痕妊娠 超声引导下局部注射氨甲蝶呤 安全性 有效性 

分 类 号：R71[医药卫生—妇产科学]