体质指数对甲氨蝶呤治疗输卵管妊娠的疗效影响

Effect of body mass index on the efficacy of methotrexate in the treatment of tubal ectopic pregnancy

目的探讨体质量指数(BMI)对输卵管妊娠妇女甲氨蝶呤治疗效果的影响。方法选取2015年2月至2018年2月于湖州市妇幼保健院接受治疗的116例输卵管妊娠患者为研究对象,按照随机数表法将患者分为单次肌注组和多次肌注组,每组各58例。单次肌注组应用甲氨蝶呤50.0mg/m^2体表面积;多次肌注组应用甲氨蝶呤0.4mg·kg^-1·d^-1,连续治疗5天。比较两组整体及按BMI分层后的疗效和不良反应情况。结果单次肌注组和多次肌注组整体及按BMI分层后的年龄、妊娠时间、血β-hCG、体表面积及B超包块直径的均衡性比较均无统计学意义,组间具有良好的可比性(均P>0.05)。单次肌注组和多次肌注组治疗输卵管妊娠的整体有效率无显著性差异(72.41%vs. 86.86%,Z=-1.882,P>0.05);多次肌注组的整体不良反应发生率显著高于单次肌注组(15.52%vs. 10.34%,χ^2=6.094,P=0.014)。按BMI分层后,BMI<25kg/m2患者的单次肌注组和多次肌注组的疗效和不良反应发生率无显著性差异(均P>0.05)。但BMI≥25kg/m2的患者中多次肌注组有效率高于单次肌注组(95.00%vs. 54.55%,Z=-2.995,P=0.003);且BMI≥25kg/m2的患者中多次肌注组的不良反应发生率也显著高于单次肌注组(40.00%vs. 4.55%,χ^2=7.821,P<0.05)。结论 BMI可能为甲氨蝶呤治疗输卵管妊娠患者的重要影响因素,当患者BMI≥25kg/m^2时,多次肌注甲氨蝶呤的治疗方案疗效更好,但同时不良反应发生率也增加。

Objective To explore the effect of body mass index(BMI) on the treatment of methotrexate in women with tubal ectopic pregnancy.Methods A total of 116 patients with tubal ectopic pregnancy and treated in Huzhou Maternal and Child Health Center from February 2015 to February 2018 were selected as research subjects.According to the random number table,the patients were divided into single intramuscular injection group and multiple intramuscular injection group,with 58 cases in each group.Then 50.0 mg/m^2 body surface area of methotrexate was used for single intramuscular injection,while multiple intramuscular injection groups were treated with methotrexate of 0.4 mg·kg^-1·d^-1 for 5 days.The efficacy and adverse reactions of two groups as a whole and stratified by body mass index were compared.Results There were no significant difference in the age,gestational time,blood β-HCG,body surface area,and B-bulk diameter between the single intramuscular and multiple intramuscular groups(all P>0.05).And no significant difference was found in the overall effective rate of tubal ectopic pregnancy between those two groups(72.41% vs. 86.86%,Z=-1.882,P>0.05).But overall adverse reaction rate in multiple intramuscular injection group was significantly higher than single intramuscular injection group(15.52% vs.10.34%,χ^2=6.094,P=0.014).After stratification by body mass index,there was no significant difference in the efficacy and adverse reaction rate between the single intramuscular injection group and the multiple intramuscular injection group in patients with BMI <25 kg/m^2(all P>0.05).However,for patients with BMI ≥25 kg/m^2,the multiple intramuscular injection group was more effective than the single intramuscular injection group(95.00% vs. 54.55%,Z=-2.995,P=0.003),and the incidence of adverse reactions in the multiple injection group was also significantly higher than that in the single intramuscular injection group(40.00% vs.4.55%,χ^2=7.821,P<0.05).Conclusion The body mass index of women with tubal ectopic pregnancy might be an important factor in the treatment of methotrexate.When the body mass index is greater than or equal to 25 kg/m2,the treatment of multiple intramuscular methotrexate is more effective,but the risk of adverse reactions also increased.