中药和中药+米非司酮保守治疗异位妊娠临床分析

Analysis on Treatment of Ectopic Pregnancy by Therapy of Chinese Herbal Medicine or Combined with Mifepristone

目的:将2种药物治疗异位妊娠(EP)的临床资料(A组:中药,B组:中药+米非司酮RU486)进行研究,总结各自的适应症和疗效,以便寻找一种更优化的药物疗法。方法:对本院自2006—2010年住院收治179例(A组92例,B组87例)稳定型EP患者的临床资料进行系统性地回顾和统计分析。结果:适应症:两组患者的年龄、血β-hCG值、孕酮值及B超附件包块的大小等方面均无显著性差异(P>0.05)。疗效:两组的成功率无显著性差异(P>0.05),A组为63.04%(58/92),B组为67.82%(59/87)。在两组成功与失败的患者中血β-hCG值均有明显差异(均P<0.01);而血β-hCG的变化趋势、孕酮值P及B超附件包块等均无显著性差异(P>0.05)。结论:2种方法治疗成功的决定因素是患者血β-hCG值,中药(1216.15±2448.14)mIU/mL、中药+RU486(1022.72±1130.19)mIU/mL,而加用RU486并没有显示更多的益处,两组患者的适应症和治愈率无明显差异,其中住院时间A组更短。因此,对符合条件的患者,采用中药治疗可能更加适合,血β-hCG≤1200mIU/mL可作为其适应症的最重要指标。

Objective：To find a more simple and effective therapy with less side-effects for ectopic pregnancy（EP）.Methods：179 patients suffering from EP were treated in two different ways.A group：92 patients were treated with Chinese herbal medicine（CHM）,B group：87 patients were treated with CHM and mifepristone（RU486）.The therapeutic effect in both groups was observed and compared.Results：There was no significant difference in initial characteristics between the two groups.There was no significant difference in the success rate of medical treatment between the CHM and CHM-RU486 group：63.04%（58/92）versus 67.82%（59/87）respectively,P=0.50240.05,non-significant.Significant difference in serumβ-hCG level was observed between successfully treated and unsuccessfully treated in each group（P〈0.01）.Other clinical effects didn＇t show significant difference,such as developing direction of serumβ-hCG,progesterone level and ectopic pregnancy size.Conclusion：Our study failed to demonstrate any benefit of the addition of mifepristone to Chinese herbal medicine.However,the key effect of success in each group was found-serumβ-hCG level,（1216.15±2448.14）mIU/mL in A group,（1022.72±1130.19）mIU/mL in B group.Criteria for Chinese herbal medicine treatment of EP may be given：serumβ-hCG≤1200mIU/mL and an ectopic pregnancy size4cm in diameter without fetal cardiac activity.For the patients who fit this criteria,treatment of CHM may be more appropriate because same success rate and less hospitalization time but less cost and side-effects,comparing with the treatment of CHM-RU486.