MTX联合米非司酮治疗异位妊娠86例临床分析

Methotrexate combined with Mifepristone in the treatment of ectopia pregnancy:clinical analysis of 86 cases

目的探讨甲氨喋呤(MTX)联合米非司酮两种应用方案保守治疗输卵管妊娠的临床疗效和不良反应。方法选择血β-人促绒毛膜性腺激素(hCG)≤2 000IU/L的输卵管妊娠病例86例,并随机分为Ⅰ、Ⅱ两组,进行前瞻性对照研究。Ⅰ组应用方案:甲氨喋呤0.4mg·kg^(-1)·d^(-1),肌内注射,共5日,联合米非司酮25mg,每日2次,口服,共5日;Ⅱ组应用方案:甲氨喋呤1mg/kg,单次肌内注射,联合米非司酮25mg,每日2次,口服,共5日。观察比较两组的临床疗效和不良反应。结果Ⅰ组治愈率为97.67%,Ⅱ组治愈率为95.34%,差异无统计学意义(P>0.05);但Ⅰ组总胃肠道反应发生率与血细胞计数下降率明显高于Ⅱ组,差异有统计学意义(X^2值分别为3.903和8.017,均P<0.05)。结论对于血β-hCG水平较低的输卵管妊娠患者应用甲氨喋呤1 mg/kg,单次肌内注射,联合米非司酮治疗,疗效可靠,不良反应轻微。

Objective To explore the clinical curative efficacy and untoward effects of two schemes of combined using Methotrexate （MTX） with Mifepristone to treat fallopian tube pregnancy. Methods Totally 86 cases of fallopian tube pregnancy whose serum β-hCG ≤2 000IU/L were randomly divided into two groups, group I and group lI to carry out prospective control study. The application scheme of group I was intramuscular injection of MTX 0.4mg . kg-1 . d-1 for 5 days, combined with Mifepristone 25mg orally two times a day for 5 days. The application scheme of group II was intramuscular injection of MTX 1mg/kg only once, combined with Mifepristone 25mg two times a day for 5 days. The clinical curative efficacy and untoward effects of two groups were observed and compared. Results The cure rate of group I was 97.67% , while that of group II was 95.34%. The difference was not statistically significant （P 〉 0.05 ）. However, the decline rate of blood corpuscle count and incidence rate of gastrointestinal tract reaction in group I were obviously higher than group II, and the differences were significant （χ2 value was 3. 903 and 8. 017, respectively, both P 〈 0.05 ）. Conclusion For cases of fallopian tube pregnancy with low serum β-hCG level, the scheme of single intramuscular injection of MTX 1mg/kg combined with Mifepristone is valuable with mild adverse effects. It is worthy of popularizing in clinics.