国际妇产科学杂志

国际妇产科学杂志 ›› 2012, Vol. 39 ›› Issue (1): 84-87.

• 论著 • 上一篇    下一篇

甲氨蝶呤单剂量肌内注射治疗异位妊娠的临床研究

黄 丽 , 洛若愚, 龚 豪, 张 蔚 ,梁 华   

  1. 430060 武汉大学第一临床学院(黄丽,龚豪);武汉大学人民医院妇科(洛若愚,张蔚,梁华)
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2012-02-15 发布日期:2012-02-15
  • 通讯作者: 洛若愚

Therapeutic Effect of Single-dose Methotrexate for Ectopic Pregnancy

HUANG Li，LUO Ruo-yu，GONG Hao，
ZHANG Wei，LIANG Hua   

  1. The First Clinical College，Wuhan University，Wuhan 430060，China（HUANG Li，GONG Hao）；Department of Gynecology，Renmin Hospital of Wuhan University，Wuhan 430060，China（LUO RUO-yu，ZHANG Wei，LIANG Hua）
  • Received:1900-01-01 Revised:1900-01-01 Published:2012-02-15 Online:2012-02-15
  • Contact: LUO Ruo-yu

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摘要： 目的：探讨影响甲氨蝶呤（methotrexate，MTX）单剂量肌内注射（肌注）治疗异位妊娠（ectopic pregnancy，EP）疗效的相关因素。 方法：回顾性分析武汉大学人民医院2006年7月—2011年7月行MTX单剂量肌注治疗的EP患者临床资料。结果：纳入269例EP患者，根据最终结局分为失败组和成功组，失败组52例（19.3%），成功组217例（80.7%）。失败组的初始血人绒毛膜促性腺激素β亚单位（β-hCG）浓度、EP史比例、妊娠周、包块直径高于成功组（P＜0.05）。多因素Logistic回归分析提示，初始β-hCG为2 000～5 000 IU/L及≥5 000 IU/L，妊娠周为6～8周及＞8周、超声包块直径≥4 cm是MTX单剂量肌注治疗失败的危险因素。患者年龄、妊娠次数、人工流产史、盆腔手术史、节育器使用史与治疗失败率无关（P＞0.05）。受试者工作特征（receiver operating characteristic，ROC）曲线选择1 871.5 IU/L为初始β-hCG预测治疗成功的阈值，敏感度为82.7%，特异度为70%，曲线下面积为 0.8（P＜0.05）。结论：初始β-hCG浓度高、妊娠时间长、包块直径大是MTX单剂量肌注治疗失败的危险因素，须谨慎行MTX单剂量肌注方案，治疗期间应密切观察。

关键词: 妊娠, 异位, 甲氨蝶呤, 危险因素, Logistic模型, ROC曲线

Abstract: Objective：To determine the risk factors for failture of an ectopic pregnancy（EP）with single-dose methotrexate. Methods：The clinical data of patients after a single-dose methotrexate for EP in Renmin Hospital of Wuhan University from July 2006 to July 2011 was reviewed retrospectively. Results：Two hundred and sixty-nine cases of EP were reviewed. The cases were divided into twogroups. One group（19.3%） were cases with ruptured EP and another group were 144 （80.7%） cases with unruptured EP. failure group and successful group according to the outcome. Fifty-two of them The mean level of pretreatment β-hCG，ratio of previous EP，mean gestation（in weeks），and size of the gestational mass were significantly higher in patients with ruptured EP compared with patients with unruptured EP（P＜0.05）. Logistic regression analysis revealed that 2 000～5 000 IU/L of pre-hCG level and≥5 000 IU/L of pre-hCG levels and also 6～8 weeks of amenorrhoea and >8 weeks of amenorrhoea and size of the gestational mass≥4 cm were the significantly risk factors for tubal rupture（P＜0.05）. No significantly associations existed regarding age，previous normal deliveries，previous induced abortion，prior pelvic surgery and use of an intra-uterine contraceptive device（IUD）. The receiver operating characteristic（ROC） curve cutoff value in the success group indicated an initialβ-hCG level of 1 871.5IU/L .At the value of 1 871.5 IU/L，sensitivity and specificity in the success group reached 82.7% and 70%. The area under the curve reached 0.8（P＜0.05）. Conclusions：Higher initial β-hCG level，higher gestational age and size of the gestational mass seem to be significant risk factors for failure of single-dose methotrexate therapy，Methotrexate should be used with caution in patients with EP.

Key words: Pregnancy, ectopic, Methotrexate, Risk factors, Logistic models, ROC curve