甲氨蝶呤全身用药治疗输卵管妊娠不同给药次数对卵巢储备功能的影响

Effect of Different Times of Administration of Methotrexate Whole Body Medication on Ovarian Reserve Function in Treatment of Tubal Pregnancy

目的:研究甲氨蝶呤(MTX)全身用药是否损伤输卵管妊娠患者的卵巢储备功能,以及一次给药与两次给药方式治疗异位妊娠后的卵巢储备功能的变化。方法:选取2015年12月-2017年4月本院因输卵管妊娠实施保守治疗的患者101例并追踪随访。根据治疗方式不同将其分为保守治疗一次给药组(A组)50例和两次给药组(B组)51例。比较两组药物治疗的毒副作用及治疗前和治疗后6个月的血抗苗勒管激素(AMH)、性激素(FSH、E_2)水平。结果:治疗后,两组AMH值均低于治疗前(t=3.173、7.123,P<0.01),但B组AMH值下降得更多,两组AMH差值比较差异有统计学意义(P<0.05);A组发生白细胞(WBC)下降、谷丙转氨酶(ALT)升高例数均少于B组(P<0.05),两组其他毒副作用发生率比较差异均无统计学意义(P>0.05);治疗前、后,两组FSH、E_2水平比较差异均无统计学意义(P>0.05),且两组治疗前后的FSH差值、E_2差值比较,差异均无统计学意义(P>0.05)。结论:MTX全身治疗会部分影响卵巢储备功能,两次给药比一次给药对卵巢储备功能影响更大,高龄孕妇可及早选择腹腔镜手术,尽量避免两次给药。

Objective:To study whether methotrexate(MTX)whole body medication can damage ovarian reserve function in patients with tubal pregnancy,and the ovarian reserve function after one time administration and two times administration of ectopic pregnancy.Method:A total of 101 patients who were treated with conservative treatment for tubal pregnancy from December 2015 to April 2017 were selected and followed up.According to the different methods of treatment,they were divided into 50 cases of conservative treatment group(group A)and 51 cases of two time administration group(group B).The toxic and side effects of two groups were compared,and the levels of blood anti Mullerian hormone(AMH)and sex hormones(FSH,E2)were observed before and 6 months after treatment.Result:After treatment,AMH values of two groups were all lower than those of before treatment(t=3.173,7.123,P<0.01),but AMH values in group B decreased more,D-value of AMH in two groups were compared,the difference was statistically significant(P<0.05).The number of white blood cell(WBC)decreased and glutamic pyruvic transaminase(ALT)increased in group A were less than those of group B(P<0.05),and the incidence of other toxic and side effects were compared,the differences were not statistically significant(P>0.05).Before and after treatment,the levels of FSH and E2 in two groups were compared,the differences were not statistically significant(P>0.05),and D-value of FSH and E2 in two groups were compared,the differences were not statistically significant(P>0.05).Conclusion:MTX whole body medication will partly affect the ovarian reserve function,and two time administration has greater impact on ovarian reserve function than once administration,so elderly pregnant women can choose laparoscopic operation as early as possible,and avoid two times of administration.