甲氨蝶呤联合米非司酮治疗异位妊娠疗效及对血清人绒毛膜促性腺激素、癌抗原125、子宫内膜厚度的影响

Efficacy of methotrexate combined with mifepristone in the treatment of ectopic pregnancy and its effect on serum human chorionic gonadotropin and cancer antigen 125 levels and endometrial thickness

目的探讨甲氨蝶呤联合米非司酮治疗异位妊娠(EP)疗效及对血清人绒毛膜促性腺激素(β-HCG)、癌抗原125(CA125)、子宫内膜厚度的影响。方法选择2017年8月至2019年8月宁波市鄞州区第二医院收治的EP患者82例为研究对象,采用随机数字表法分为对照组和观察组,每组41例,对照组给予甲氨蝶呤治疗,观察组加用米非司酮治疗,评估两组临床疗效,观察两组不良反应、临床相关恢复指标,对比两组治疗前后的血清生化指标、子宫内膜厚度及包块直径大小。结果观察组的临床总有效率为95.12%(39/41),显著高于对照组的75.61%(31/41)(χ^(2)=6.248,P<0.05);观察组的不良反应总发生率为4.88%(2/41),显著低于对照组的19.51%(8/41)(χ^(2)=4.100,P<0.05);治疗后,对照组和观察组血清β-HCG、CA125、孕酮(P)及血管内皮生长因子(VEGF)水平分别为(1106.26±122.36)U/L和(902.65±61.32)U/L、(32.26±6.86)kU/L和(28.26±5.26)kU/L、(15.33±3.01)nmol/L和(10.33±1.92)nmol/L及(85.36±16.41)ng/L和(65.33±12.22)ng/L,较治疗前均显著降低(t=56.964和82.206、12.380和17.642、9.976和19.471、7.490和12.912,均P<0.05),观察组显著低于对照组(t=10.624、3.304、8.967、6.991,均P<0.05);治疗后,对照组和观察组子宫内膜厚度、包块直径分别为(8.23±1.81)mm和(6.25±1.25)mm、(2.21±0.52)cm和(1.52±0.35)cm,较治疗前均显著减少(t=3.555和15.118、11.631和24.167,均P<0.05),观察组显著低于或少于对照组(t=6.248、7.861,均P<0.05);治疗后,对照组和观察组的症状消失时间、血β-HCG恢复正常水平时间、尿β-HCG转阴时间、盆腔包块消失时间、住院时间分别为(7.26±1.92)d和(4.23±0.85)d、(16.25±3.82)d和(12.33±2.21)d、(15.36±3.26)d和(10.66±2.12)d、(24.12±4.12)d和(18.66±3.61)d、(29.58±5.68)d和(23.52±4.36)d,观察组均显著短于对照组(t=10.305、6.343、8.631、7.118、6.044,均P<0.05)。结论甲氨蝶呤联合米非司酮治疗EP疗效显著,可减少不良反应,能降低血清β-HCG、CA125、P及VEGF水平,促进血β-HCG水平恢复正常、子宫内膜变薄和附件区包块消失,利于患者及早康复,临床应用安全性良好。

Objective To investigate the efficacy of methotrexate combined with mifepristone in the treatment of ectopic pregnancy and its effect on serum human chorionic gonadotropin(β-HCG)and cancer antigen 125(CA125)levels and endometrial thickness.Methods Eighty-two patients with ectopic pregnancy who received treatment in Ningbo Yinzhou No.2 Hospital,China from August 2017 to August 2019 were included in this study.They were randomly assigned to receive treatment with methotrexate(control group,n=41)or methotrexate combined with mifepristone(observation group,n=41).Clinical efficacy was evaluated,and adverse reactions and clinical recovery indexes were observed in each group.Before and after treatment,serum biochemical indexes,endometrial thickness and mass diameter were compared between the observation and control groups.Results Clinical efficacy in the observation group was significantly higher than that in the control group[95.12%(39/41)vs.75.61%(31/41),χ^(2)=6.248,P<0.05].The incidence of adverse reaction in the observation group was significantly lower than that in the control group[4.88%(2/41)vs.19.51%(8/41),χ^(2)=4.100,P<0.05].After treatment,serumβ-HCG,CA125,progesterone and vascular endothelial growth factor levels in the control and observation groups were(1106.26±122.36)U/L and(902.65±61.32)U/L,(32.26±6.86)kU/L and(28.26±5.26)kU/L,(15.33±3.01)nmol/L and(10.33±1.92)nmol/L,(85.36±16.41)ng/L and(65.33±12.22)ng/L,respectively,which were significantly lower than those before treatment(t=56.964 and 82.206,12.380 and 17.642,9.976 and 19.471,7.490 and 12.912,all P<0.05).After treatment,serumβ-HCG,CA125,progesterone and vascular endothelial growth factor levels in the observation group were significantly lower than those in the control group(t=10.624,3.304,8.967,6.991,all P<0.05).After treatment,endometrial thickness and mass diameter in the control and observation groups were(8.23±1.81)mm and(6.25±1.25)mm,(2.21±0.52)cm and(1.52±0.35)cm respectively,which were significantly lower than those before treatment(t=3.555 and 15.118,11.631 and 24.167,both P<0.05).After treatment,endometrial thickness and mass diameter in the observation group were significantly less or smaller than those in the control group(t=6.248 and 7.861,both P<0.05).After treatment,symptom disappearance time,serumβ-HCG recovery time,urineβ-HCG negative time,pelvic mass disappearance time and hospital stay in the control and observation groups were(7.26±1.92)d and(4.23±0.85)d,(16.25±3.82)d and(12.33±2.21)d,(15.36±3.26)d and(10.66±2.12)d,(24.12±4.12)d and(18.66±3.61)d,(29.58±5.68)d and(23.52±4.36)d,respectively.After treatment,symptom disappearance time,serumβ-HCG recovery time,urineβ-HCG negative time,pelvic mass disappearance time and hospital stay in the observation group were significantly shorter than those in the control group,respectively(t=10.305,6.343,8.631,7.118,6.044,all P<0.05).Conclusion Methotrexate combined with mifepristone is highly effective in the treatment of ectopic pregnancy because it can reduce adverse reactions,decrease serumβ-HCG,CA125,progesterone and vascular endothelial growth factor levels,promote the recovery of serumβ-HCG to normal level,reduce endometrial thickness,and promote adnexal mass disappearance,which are conducive to the early recovery of patients,with good clinical safety.