甲氨蝶呤两种方案治疗异位妊娠的临床研究

Clinical study of two methotrexate regimens in the treatment of ectopic pregnancy

目的 探讨对异位妊娠患者进行药物治疗时使用两种不同甲氨蝶呤(methotrexate,MTX)治疗方案的临床疗效,为临床制定药物治疗方案提供理论依据。方法 选取2018年6月30日至2021年6月30日收治于同济大学附属第一妇婴保健院急诊妇科进行MTX治疗的异位妊娠患者(共计548例)作为研究对象,根据MTX治疗方案的不同,分为A组(单剂量方案组,n=495)和B组(两剂量方案组,n=53),对两组患者的临床数据特征及治疗结局等数据进行比较分析。结果 A组住院时间中位数为10.00(7.50,14.50)d,B组住院时间中位数为16.75(13.87,20.00)d,两组总体住院时间分布存在统计学差异(Z=-5.774,P<0.001)。A组住院费用中位数为3 945.00(2 880.30,5 166.50)元,B组住院费用中位数为4 889.60(4 106.30,6 697.68)元,两组总体住院费用分布存在统计学差异(Z=-3.714,P<0.001)。A组血清β-HCG恢复时间的中位数为20.00(14.00,26.00)d,B组血清β-HCG恢复时间的中位数为23.50(18.00,30.00)d,两组总体血清β-HCG恢复时间分布存在统计学差异(Z=-2.816,P=0.005)。两组治疗成功率、重复单次给药率、包块消失时间及不良反应发生率均无统计学差异(P>0.05)。结论 MTX两种治疗方案在异位妊娠保守治疗中均安全、有效,单剂量方案在住院时间及住院费用方面性价比更高。

Objective To explore the clinical efficacy of two groups of different methotrexate(MTX) treatment schemes patients with ectopic pregnancy,and provide theoretical basis for clinical treatment.Methods A total of 548 patients with ectopic pregnancy treated with MTX in our hospital from June 30,2018 to June 30,2021 were selected as the research objects.According to different MTX treatment schemes,they were divided into group A(single-dose regimen group,n=495) and group B(two-dose regimen group,n=53).The clinical data characteristics and treatment effects of the two groups were compared and analyzed.Results The median of hospitalization time in group A was 10.00(7.50,14.50) days,and that was 16.75(13.87,20.00) days in group B,and there was significant difference in the average hospitalization time between the two groups(Z=-5.774,P<0.001).The median hospitalization cost in group A was 3945.00(2880.30,5166.50) yuan,and that was 4889.60(4106.30,6697.68) in group B,and there was a statistical difference in the overall distribution of hospitalization cost between the two groups(Z=-3.714,P<0.001).The median time of serum β-HCG turning negative was 20.00(14.00,26.00) days in group A and 23.50(18.00,30.00) days in group B,and there was a statistical difference in the time distribution of serum β-HCG turning negative between the two groups(Z=-2.816,P=0.005).There were no significant differences between the two groups in the success rate of treatment,the rate of repeated single administration,the disappearance time of mass and the incidence of adverse reactions(P>0.05).Conclusion Both MTX treatment regimens are safe and effective in the conservative treatment of ectopic pregnancy.The single dose regimen more cost-effective in terms of hospitalization time and hospitalization expenses.