甲氨蝶呤治疗异位妊娠疗效预测因素分析

Outcome prediction of methotrexate treatment in ectopic pregnancies

目的:分析一种新的甲氨蝶呤(MTX)方案治疗异位妊娠(EP)疗效的影响因素和建立预测其成功的治疗前血清人绒毛膜促性腺激素(hCG)临界值。方法:收集31例EP患者临床资料;采用MTX 1 mg/kg,分3次间隔48 h肌注给药治疗。分析血清hCG等因素对MTX治疗EP近期疗效的影响。结果:治愈24例(77.4%),治疗失败7例;治愈组治疗前血清hCG低于治疗失败组(P=0.022);血清hCG水平是与MTX治愈EP显著相关的唯一因素(P=0.036,Logistic回归);血清hCG最佳工作点为1 603 m IU/m L(灵敏度87.5%,特异度57.1%,接受者工作特征曲线分析)。结论:本MTX方案治疗EP,初始血清hCG水平是影响治疗成败的重要预测因素,初始hCG>1603 m IU/m L,治疗很可能失败,必要时应考虑改变治疗方案。

AIM： To analyze the predictors of success in a novel methotrexate（ MTX） protocol of ectopic pregnancies（ EPs） and create a cutoff of pretreatment human chorionic gonadotropin（ h CG）in the successful MTX treatment of EPs. METHODS： A group of 31 hemodynamicaly stable women,absence of yolk sac and fetal cardiac activity on transvaginal ultrasonography,no desire for surgical treatment,and with no hepatic,hematologic or renal disease,was electively treated with the MTX protocol（ overall intramuscular dosage of 1 mg / kg divided to 3 doses at 48-hour intervals given as a course）. The diagnosis of EP was made by a nonlaparoscopically algorithm. The size and the volume of the gestational mass,presence of previous EP,total MTX dosage that patients actually accepted and the pretreatment serum h CG levels were accessed,and their prognostic value for primary outcome of MTX treatment of EPs was investigated. RESULTS： 24 cases（ 77. 4%） were successfully cured. In these cases,the log-transformed serum h CG levels before MTX administration were lower compared with the levels found in cases of therapeutic failure（ 2. 75 ± 0. 38 vs. 3. 14 ± 0. 33,respectively; P = 0. 022）. The receiver operating characteristic（ ROC） curve analysis showed that a pretreatment serum h CG concentration≤1 603 m IU / m L was a factor indicative of therapeutic success with sensitivity of 87. 5% and specificity of 57. 1%. Logistic regression analysis revealed the initial serum h CG concentration to be the only factor that contributed to the success rate（ P = 0. 036）. CONCLUSION： In the protocol,the pretreatment serum concentration of h CG is an important prognostic factor associated with MTX success therapy of EP. When the pretreatment h CG level is 〉1 603 m IU / m L,the MTX treatment of EP is at risk of failure.