米非司酮配合甲氨蝶呤对不同黄体血流分级未破裂型输卵管妊娠患者激素水平及再次妊娠的研究

Study on the effect of mifepristone combined with methotrexate on hormone levels and subsequent pregancy of unruptured tubal pregnancy patients with different corpus luteum blood flow grades

目的探讨米非司酮配合甲氨蝶呤对不同黄体血流分级未破裂型输卵管妊娠患者疗效及激素水平和再次妊娠的影响,为该类患者的临床治疗提供参考依据。方法选取未破裂型输卵管妊娠患者80例,根据黄体血流分级不同分为1级组20例、2级组30例、3级组30例。3组均予注射用甲氨蝶呤、注射用水2 ml溶解后肌内注射,共5 d;口服米非司酮片,50 mg/次,2次/d,共6 d。比较3组患者治疗有效率、包块平均直径、血β-人绒毛膜促性腺激素(β-h CG)水平及再次妊娠情况。结果 1级组患者治疗有效率95.00%明显高于3级组66.67%,差异有统计学意义(P<0.05);2级组有效率76.67%低于1级组但高于3级组,但组间比较差异无统计学意义(P>0.05)。治疗后6 d,2级组和3级组患者的β-h CG水平和包块平均直径均明显高于1级组患者,3级组β-h CG水平和包块平均直径显著高于2级组患者,3组差异均有统计学意义(P<0.01)。治疗后随访2年,1级组宫内孕率80.00%明显高于3级组的43.33%,差异有统计学意义(P<0.05);随着黄体血流分级增高,患者的继发不孕和重复输卵管妊娠发生率增加,但差异无统计学意义(P>0.05)。结论随着黄体血流分级增加,米非司酮联合甲氨蝶呤对未破裂型输卵管妊娠的疗效降低,对β-h CG和再次妊娠的改善越差。

Objective To explore the effect of mifepristone combined with methotrexate on hormone levels and subsequent pregancy of unruptured tubal pregnancy patients with different corpus luteum blood flow grades,provide a reference basis for clinical treatment.Methods Eighty patients with unruptured tubal pregnancy were selected and divided into grade one group（20 patients）,grade two group（30 patients）,and grade three group（30 patients） according to corpus luteum blood flow grades. The patients in the three groups were treated with intramuscular injection of methotrexate（five days） and oral administration of mifepristone（50 mg per time,twice a day,six days）.The effective rates,the mean diameters of masses,the levels of blood β-human chorionic gonadotropin（β-h CG）,subsequent pregancy in the three groups were compared. Results The effective rate in grade one group was 95. 00%,which was statistically significantly higher than that in grade three group（66. 67%）（P〈0. 05）. The effective rate in grade two group was 76. 67%,which was lower than that in grade three group,but there was no statistically significant difference（P〈0. 05）. At six days after treatment,the levels of β-h CG and the mean diameters of masses in grade two group and grade three group were statistically significantly higher than those in grade one group,the level of β-h CG and the mean diameter of masses in grade three group were statistically significantly higher than those in grade two group（P〈0. 01）. At two years after treatment,the rate of intrauterine pregnancy in grade one group was 80. 00%,whih was statistically significantly higher than that in grade three group（43. 33%）（P〈0. 05）. With the increase of corpus luteum blood flow grades,the incidence rates of secondary infertility and repeated tubal pregnancy increased, but there was no statistically significant difference（P〈0. 05）.Conclusion With the increase of corpus luteum blood flow grades,the curative effect of mifepristone combined with methotrexate in treatment of unruptured tubal pregnancy decreases,and the improvements of β-h CG level and subsequent pregancy are bad.