甲氨蝶呤治疗异位妊娠疗效及失败因素的评价

目的 探讨甲氨蝶呤单次肌肉注射治疗异位妊娠的疗效, 并分析其治疗失败的相关因素。 方法 对比分析成功组及失败组的临床资料, 包括停经天数、治疗前β-HCG 值、包块直径、腹痛情况、治疗3 d后β-HCG 值下降率及包块直径改变情况。 结果 成功组停经天数平均为53 ±5 d, β-HCG 值平均为1483 ±216 IU·L^-1, 包块直径平均为2.9 ±0.9 cm;失败组停经天数平均为62 ±6 d, β-HCG 值平均为6661 ±126 IU·L^-1, 包块直径平均为4.1 ±0.6 cm。成功组有14.3 %的病人停经天数≥60 d, 11.4 %的病人血β-HCG 值≥4 000 IU·L^-1, 治疗3 d 后β-HCG 值下降率≤15 %的为14.3 %, 包块直径增加≥25 %的为7.9 %;而失败组各数值分别为40.0 %、80.0 %、60.0 %、40.0 %。 结论 甲氨蝶呤是一种有效的治疗早期异位妊娠的药物;治疗前的β-HCG值、治疗3 d 后β-HCG 值下降率及包块直径改变情况与治疗失败关系极大;胎心搏动并非为异位妊娠药物治疗的禁忌证。

Evaluation of therapeutic efficacy and failure factors of methotrexate in treatment of ectopic pregnancy

AIM: To evaluate the therapeutic efficacy and failure factors in single dose methotrexate intramusculr injection in treatment of ectopic pregnancy. METHODS: The clinical data of 70 successfully treated cases and 10 failed cases were analyzed comparatively, including the duration of menoschesis, serum β-HCG level, diameter of adnexa mass and abdominal pain before treatment as well as the decline rate of serum β-HCG level and change of mass diameter after 3 d of treatment. RESULTS: In succeeded group, the average duration of menoschesis, the mean level of serum β-HCG and average diameter of adnexa mass were 53 ±5 d (14.3 % of patients ≥60 d), 1483 ±216 IU·L^-1 (11.4 %of patients ≥4000 IU·L^-1) and 2.9 ±0.9 cm(7.9 % of patients showed increase of mass diameter ≥25 %), respectively; whereas in failed group, these corresponding figures were 62 ±6.d(40.0 %), 6661 ±126 IU·L^-1 (80.0 %), 4.1 ±0.6 cm (40.0 %), respectively.After 3 d of treatment, 14.3 % of patients in succeeded group revealed a decline rate of serum β-HCG level ≤15 %, while 60.0 % of patients in failed group revealed a similar decline rate. CONCLUSION: Methotrexate is an effective drug for treating ectopic pregnancy in its early stage.The serum β-HCG level before treatment, its decline rate and the change of adnexa mass diameter after 3 d of treatment are closely related to the therapy failure.Presence of fetus heart beating is not a contraindication for drug treatment of ectopic pregnancy.