甲氨喋呤联合米非司酮对异位妊娠的治疗效果

Therapeutic efficacy of methotrexate combined with mifepristone for ectopic pregnancy

目的 探讨不同剂量甲氨喋呤给药方式联合米非司酮治疗异位妊娠的临床疗效.方法 将116例异位妊娠患者随机分为甲氨喋呤单次剂量组（A组）60例和甲氨喋呤多次剂量组（B组）56例,对两组分别联合米非司酮进行保守治疗,观察两组治疗的成功率及毒副作用.结果 ①A组与B组的治疗成功率比较差异无统计学意义（χ2=1.406,P〉0.05）;②当血β-人绒毛膜促性腺激素在〈1 000mIU/mL、1 000～3 000mIU/mL时,A、B两组保守治疗成功率比较差异均无统计学意义（均P〉0.05）,而在其〉3 000mIU/mL时,保守治疗的成功率比较差异有统计学意义（确切概率法P=0.015〈0.05）;③在116例患者中,保守治疗成功98例,失败18例,治疗前血β-人绒毛膜促性腺激素水平比较差异有统计学意义（t=-5.530,P〈0.05）;④A、B两组胃肠道副反应（χ2=8.560,P〈0.05）和口腔溃疡（确切概率法P=0.048〈0.05）的发生率比较差异均有统计学意义,而白细胞减少和肝肾功损害发生率之间比较差异均无统计学意义（均P〉0.05）.结论 ①单次、多次甲氨喋呤剂量联合米非司酮治疗异位妊娠具有相似的疗效;②治疗前血β-人绒毛膜促性腺激素是影响疗效的主要因素之一;③单次剂量实施简单、反应低,毒副作用少于多次剂量.

Objective To investigate the clinical efficacy of muhiple and single dose of methotrexate （MTX） combined with mifepristone （RU486） for ectopic pregnancy. Methods 116 cases of ectopic pregnancy were randomly divided into MTX single dose group （group A, 60 cases） and MTX multiple doses group （group B, 56 cases）. Two groups received conservative treatment with RU486, and the success rate and side effects were compared. Results The difference in treatment success rate between two groups was not significant （χ2 = 1. 406, P 〉 0.05 ）. There were no significant difference in the success rate between two groups when β-hCG level was less than 1 000mIU/mL and when it was between 1 000 and 3 000mIU/mL （ both P 〉 0.05 ）, while the difference was significant when β-hCG level was more than 3 000mIU/mL （exact propability P 〈 0.05）. Conservative treatment was successful in 98 cases, and 18 cases failed. The difference in blood β-hCG before treatment between two groups was statistically significant （t = - 5. 530, P 〈 0.05）. The incidence of gastrointestinal adverse reaction （χ2 = 8. 560, P 〈 0.05 ） and oral ulcers （ exact propability P 〈 0.05 ） of two groups was significantly different, but the differences in leucopenia and damage to liver and kidney function were not statistically significant （ both P 〉 0.05 ）. Conclusion The efficacy of single dose and multiple doses of MTX combined with RU486 for ectopic pregnancy is similar. Pre-treatment blood β-hCG is one of the major influencing factors of therapeutic effect. Single dose regimen is simple with low and less side effects.