不同甲氨蝶呤用药方案联合米非司酮治疗异位妊娠疗效观察

Clinical efficacy of different regimens of methotrexate combined with mifepristone in the treatment of ectopic pregnancy

目的探讨不同甲氨蝶呤用药方案联合米非司酮治疗异位妊娠(EP)的临床疗效。方法选择深圳市龙岗中心医院妇产科于2015年6月至2016年6月期间收治的82例EP患者为研究对象,根据随机数表法将其分为观察组和对照组,每组41例,对照组患者应用连续肌肉注射甲氨蝶呤[0.4 mg/(kg·d),1次/d,连用5 d],观察组予单次肌肉注射(1 mg/kg),均同时口服米非司酮(25 mg,2次/d,连用3 d)。比较两组患者的临床疗效及不良反应发生情况。结果治疗7 d后观察组患者的血清人绒毛膜促性腺激素(β-h CG)下降率为(49.89±16.45)%,明显高于对照组的(32.16±11.24)%,差异有统计学意义(P<0.05);而两组治疗14 d时血β-h CG下降率比较差异无统计学意义(P>0.05);观察组患者的治愈时间为(16.67±3.65)d,短于对照组的(18.39±4.01)d,差异有统计学意义(P<0.05);观察组与对照组患者的治愈率分别为95.12%和87.80%,差异无统计学意义(P>0.05);观察组不良反应发生率为26.83%,明显低于对照组的48.78%,差异有统计学意义(P<0.05)。结论连续肌肉注射、单次肌肉注射甲氨蝶呤联合米非司酮均是治疗异位妊娠的有效方法,但是单次肌肉注射法降低血β-h CG的速度更快,且不良反应发生率低,安全性更佳。

Objective To investigate the clinical efficacy of different regimens of methotrexate combined with mifepristone in the treatment of ectopic pregnancy（EP）. Methods Eighty-two patients with EP treated in Department of Obstetrics and Gynecology in our hospital from June 2015 to June 2016 were selected as the research objects, which were randomly divided into the observation group and control group according to the random number method, with 41 cases in each group. The control group was treated with continuous intramuscular injection of methotrexate（0.4 mg· kg-1· d-1,qd × 5 d）, and the observation group received single intramuscular injection of methotrexate（1 m/kg）, both combined with oral mifepristone（25 mg, bid×3 d）. The clinical efficacy and adverse reactions were compared between the two groups. Results Seven days after treatment, the serum β-human chorionic gonadotropin（β-h CG） decline rate in observation group was（49.89±16.45）%, significantly higher than（32.16±11.24）% in the control group（P〈0.05）, but the β-h CG decline rate at 14 days after treatment showed no statistically significant difference between the two groups（P〈0.05）. The cure time in observation group was（16.67±3.65） d, which was significantly shorter than（18.39±4.01） d in the control group（P〈0.05）. The cure rate in observation group and control group（95.12% and 87.80%） showed no significant difference（P〉0.05）. The adverse reactions rate in observation group was 26.83%, significantly lower than 48.78%in the control group（P〈0.05）. Conclusion Continuous intramuscular injection or single intramuscular methotrexateare combined with mifepristone are effective in the treatment of ectopic pregnancy, but single intramuscular injection method can reduce β-h CG faster, with lower incidence of dysplasia and better safety.