单剂量和改良双剂量甲氨蝶呤方案治疗异位妊娠的对比分析

Comparison of single-dose and modified two-dose methotrexate in the treatment of ectopic pregnancy

目的探讨甲氨蝶呤(MTX)单剂量与改良双剂量方案治疗异位妊娠的有效性。方法收集2015年8月-2019年8月于广东省第二人民医院妇科住院并采用MTX治疗的所有异位妊娠患者的临床资料,根据用药方案将其分为MTX单剂量组108例和MTX改良双剂量组69例。观察各组患者治疗的成功率、再次入院率、血清人绒毛膜促性腺激素(β-hCG)恢复至正常时间、住院时间、住院费用及不良反应发生情况。结果改良双剂量组治疗的成功率高于单剂量组(85.5%vs.72.2%),差异有统计学意义(χ^(2)=5.34,P=0.02);单剂量组和改良双剂量组的再次入院率分别为4.6%和2.9%,差异无统计学意义(χ^(2)=0.03,P=0.86)。治疗成功的患者中,双剂量组患者的血清β-hCG恢复至正常所需时间较单剂量组短[(22±11)d vs.(25±44)d],但差异无统计学意义(P>0.05);双剂量组患者住院时间和费用均高于单剂量组患者[(7.2±2.1)d vs.(6.6±1.7)d]、[(3605.3±710.3)元vs.(3342.6±1356.7)元],但差异均无统计学意义(均P>0.05)。两组患者不良反应发生率差异无统计学意义(P>0.05)。结论与MTX单剂量方案治疗相比,改良双剂量方案治疗异位妊娠的成功率更高、随访时间更短,是一种治疗异位妊娠的有效方案。

Objective To compare the effectiveness of single-dose methotrexate(MTX)and modified double-dose regimen in the treatment of ectopic pregnancy.Methods We collected the clinical data of all patients with ectopic pregnancy hospitalized in the department of gynaecology of Guangdong Sencond Provincial General Hospital and treated with MTX from August 2015 to August 2019,and they were divided into MTX single-dose group and MTX modified double-dose group according to the medication regimen.We Observed the treatment success rate,readmission rate,serum human chorionic gonadotropin(β-hCG)return to normal time,hospital stay and costs,and adverse reactions between the two groups.Results A total of 177 patients were treated with MTX,including 108 in the single-dose group and 69 in the modified double-dose group.The success rate of treatment in the modified double-dose group was higher than that in the single-dose group(85.5%vs.72.2%),and the difference was statistically significant(χ^(2)=5.34,P=0.02).Readmission rates in the single-dose group and the modified double-dose group were 4.6%and 2.9%,respectively,with no statistically significant difference(χ^(2)=0.03,P=0.86).Among the patients who were treated successfully,the time required for serumβ-hCG to return to normal in the double-dose group was shorter than that in the single-dose group[(22±11)d vs.(25±44)d],but the difference was not statistically significant(P>0.05);the hospital stay and costs of patients in the double-dose group were higher than those in the single-dose group[(7.2±2.1)d vs.(6.6±1.7)d],[(3605.3±710.3)yuan vs.(3342.6±1356.7)yuan],but the differences were not statistically significant(P>0.05).There was no significant difference in the incidence of adverse reactions between the two groups of patients(P>0.05).Conclusion Compared with the single-dose regimen of MTX,the modified double-dose regimen has a higher success rate and shorter follow-up time.Which is an effective regimen for ectopic pregnancy.