甲氨蝶呤辅助天花粉保守治疗高血清β-HCG水平输卵管妊娠

Effect of trichosanthin assisted by methotrexate on conservative treatment of tubal pregnancy with high serum β-HCG level

目的:观察甲氨蝶呤(MTX)辅助天花粉保守治疗高血清β-绒毛膜促性腺激素(β-HCG)水平输卵管妊娠的效果。方法:对96例确诊为高血清β-HCG水平输卵管妊娠(未破裂)天花粉保守治疗的患者,血β-HCG>2 000 U/L,最高26 699 U/L,肌肉注射结晶天花粉蛋白1.8 mg,给药后复查血β-HCG、B超检查,动态观察血β-HCG水平、附件包块变化及腹痛、盆腔积液情况。治疗观察发现30例血β-HCG水平下降明显,但下降停滞平台或反弹,并无急腹症表现,加用MTX50 mg/m2单次肌肉注射治疗,或1 mg/kg肌肉注射,隔日一次,共4次,次日始四氢叶酸(CF)0.1 mg/kg肌肉注射,隔日一次,共4次,继续观察治疗效果。结果:96例高血清β-HCG水平输卵管妊娠患者中天花粉保守治疗,66例治愈,加用MTX辅助治疗30例,治愈26例,失败4例,治愈率86.67%。结论:天花粉用于高血清β-HCG水平输卵管妊娠保守治疗过程中及时加用MTX可取得较理想疗效。

Objective： To observe the effect of trichosanthin assisted by methotrexate （MTX） on conservative treatment of tubal pregnancy with high serum β -human choriouic gonadotropin （β-HCG） level. Methods： A total of 96 cases with unruptured tubal preg- nancy with high serum β- HCG level （serum β -HCG 〉2 000 U/L, maximum level： 26 699 U/L） were treated with intramuscular injec- tion of crystalline trichosanthin protein （ 1.8 mg）, reexamination of serum β - HCG and uhrasonography were performed; serum β - HCG level, change of adnexa uteri masses, abdominal pain, and pelvic effusion were observed dynamically; serum β - HCG levels of 30 cases without manifestations of acute abdomen decreased significantly during treatment, then they were treated with intramuscular injection of MTX ; then the curative effect was observed. Results： Among 96 cases, 66 cases were cured, 30 eases were treated with trichosanthin assisted by MTX, 26 eases were cured, and 4 eases failed, the curative rate was 86. 67%. Conelusioll： Trichosanthin assisted by MTX can obtain ideal curative effect for conservative treatment of tubal pregnancy with high serum β - HCG level.