输卵管妊娠治疗方式及其对未来生育影响的研究进展

输卵管妊娠是一种临床常见的妇科急腹症。输卵管妊娠如能在包块尚未破裂前早期诊断，其相关的病死率大大降低。输卵管妊娠的治疗方式有很多，无论哪种治疗方式，都会导致患者生育功能的下降。临床中对于有生育要求的患者，选择哪种治疗方式更好地保护患者的生育功能并减少并发症仍是有争议的话题。近年有学者做了大量研究比较输卵管妊娠不同治疗方式的并发症及其对患者未来生育前景的影响，甚至提出更新的治疗方式以弥补传统治疗方式的不足。现就输卵管妊娠的治疗方式、并发症及对未来生育的影响的研究进展进行综述。     

宫内外复合妊娠的诊断与治疗

宫内外复合妊娠(heterotopic pregnancy,HP)是一种病理性妊娠疾病,在自然妊娠中较为罕见,但随着辅助生殖技术的发展,其发病率逐渐增加.输卵管因素和辅助生殖技术的应用是HP发病的主要因素.经阴道超声和血人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)值的联合应用可...     

中西药结合治疗输卵管妊娠的疗效分析

目的探讨中西药结合治疗输卵管妊娠的临床效果。方法56例未破裂型输卵管妊娠患者,将其分成两组,中西药结合组40例给予甲氨喋呤(MTX)多次静脉注射,次日加四氢叶酸钙解毒,并辅以具有灭胚胎及活血化瘀作用的中药治疗。对照组16例,MTX多次静脉注射,次日加四氢叶酸钙解毒。治疗后定期检查血-βHCG及B超,注意患者的腹痛、阴道流血、腹泻、肛门坠胀感、黑色大便等及生命体征情况。结果中西药结合组38例治愈,治愈率95.00%,血-βHCG平均3.6 d开始下降,18.7 d下降为正常,47.5%呈现一过性上升;再次异位妊娠率2.5%;副反应发生率30.00%。对照组15例治愈,治愈率93.75%,血HCG平均9.9d开始下降,28.9 d下降为正常。两组相比,治愈率无显著性差异,血-βHCG下降时间和速度均有显著性差异(P<0.05)。结论符合保守治疗条件的输卵管妊娠患者采用中西药结合治疗效果良好,疗程缩短。     

米非司酮与甲氨蝶呤预防持续性异位妊娠的疗效比较

目的:对比观察米非司酮与甲氨蝶呤辅助防治输卵管妊娠腹腔镜保守性手术后持续性异位妊娠(Persis-tent Ectopic Pregnancy,PEP)的疗效。方法:144例输卵管妊娠行腹腔镜保守性手术的患者,随机分成观察组72例和对照组72例,观察组患者术后服用米非司酮150mg,对照组患者于术中输卵管局部注射甲氨喋呤20mg。结果:两组病例均无PEP发生,术后第一天两组患者血清人绒毛膜促性腺激素(β-HCG)均有大幅度下降,且术后第1、3、5、12天两组血清β-HCG的下降率无明显差异(P>0.05)。结论:米非司酮与甲氨蝶呤防治PEP的疗效相同     

氨甲蝶呤给药途径对异位妊娠的临床疗效的疗效评价

目的：评价不同给药途径氨甲蝶呤（MTX）治疗早期异何妊娠临床效果。方法：A和B组分别采用肌肉和静脉注射MTX：C组采用经阴道超声引导穿刺胚囊注射MTX。结果：C组临床治愈率（100％）明显高于A组和B组。结论：经阴道超声引导穿刺胚囊注射MTX是治疗异位妊娠最合适的给药途径。     

氨甲喋呤诱导的大鼠持续性肠黏膜损伤模型的建立与评价

摘要: 目的：建立一种大鼠肠黏膜持续损伤模型。方法：SD大鼠腹腔注射氨甲喋呤（MTX）建立肠黏膜炎模型。100只大鼠随机分为空白组(Control Group)、模型组Ⅰ（MTX Group Ⅰ）、模型组Ⅱ (MTX Group Ⅱ)和模型组Ⅲ (MTX Group Ⅲ),其中MTX Group Ⅰ10只大鼠,其余每组各30只。第0天,MTX Group Ⅰ大鼠注射MTX （20 mg/kg）,MTX Group Ⅱ和 MTX Group Ⅲ大鼠注射MTX（10 mg/kg）。第6天,MTX Group Ⅱ大鼠再次注射MTX 10 mg/kg,MTX Group Ⅲ大鼠注射MTX 5 mg/kg。Control Group在第0天和第6天均注射生理盐水。实验期间观察大鼠活动状态,并记录进食量和体重变化。MTX Group Ⅰ在第4天全部处死,其余每组于造模后第4、5、6、10、11、12天各处死5只大鼠,HE染色进行病理学分析,并检测血浆中的D-乳酸、二胺氧化酶(DAO)及小肠组织中的髓过氧化物酶(MPO)、丙二醛(MDA)水平。结果：在第4天时,三个模型组大鼠小肠组织损伤评分(Chiu评分)均明显高于Control Group (p<0.05),血浆中D-乳酸含量、DAO活力及小肠组织中MPO活力、MDA含量也均显著高于Control Group (p<0.05)。在第5天时MTX Group Ⅱ和 MTX Group Ⅲ大鼠小肠黏膜损伤程度开始恢复,Chiu评分、D-乳酸含量、DAO活力、MPO活力和MDA含量逐渐降低,在第6天时与Control Group基本无差异。二次注射后,在第10天,MTX Group Ⅱ和 MTX Group Ⅲ大鼠Chiu评分再次升高,血浆中D-乳酸含量、DAO活力及小肠组织中MPO活力、MDA含量也显著高于Control Group (p<0.05),之后逐渐降低,损伤再次恢复。与MTX Group Ⅱ相比,二次注射后MTX Group Ⅲ损伤程度较轻（p<0.05）。结论：20 mg/kg MTX诱发大鼠肠黏膜炎是一个急性损伤过程,整个病程大约为4至5天,适用于药物治疗评价;两次间歇式10 mg/kg注射MTX可以造成大鼠肠黏膜的持续损伤,该模型更加适合中长期的营养治疗评价。     

The Absence of HIV Mutations in Cerebrospinal Fluid and in Peripheral Blood Mononuclear Cells During a Regimen Containing Trizivir Plus Tenofovir

Abstract

Methotrexate (MTX) is widely used in the treatment of hematological diseases. The typical side-effects of high-dose MTX chemotherapy on the CNS range from asymptomatic white matter changes to severe CNS demyelination. MTX neuro - toxicity has been described to be associated with homocysteine and folate levels as well as genetic variants affecting methionine metabolism. Here we describe a case of severe, acute MTX-induced encephalopathy in a patient who was found to be homozygous for the rare missense variant methionine synthase (MTR) c.2756A>G (D919G), which may have modified the effect of MTX on homocysteine metabolism. This finding encourages further studies to determine to what extent the individual conditions of folate and methionine metabolism influence the effects or side-effects of MTX treatment.     

Tc-99m diethylenetriamine pentaacetic acid (DTPA): Is it reliable for assessment of methotrexate-induced cumulative effect on renal filtration in rheumatoid arthritis patients?

Methotrexate[MTX] is commonly employed as the initial DMARD used for treatment of Rheumatoid arthritis[RA]. We aimed to contribute to the safety profile of MTX by assessing its cumulative effect on renal filtration. Fifty two RA adult females with normal base-line serum creatinine and GFR at the initial diagnosis of the disease were included. Group-1[G1] included 30 patients[mean age 40.4 ± 4.4 years] on MTX and NSAIDS, while 22 RA patients[mean age 38.5 ± 8.2 years] who received NSAIDs only served as the control group[G2]. Renal function was assessed by GFR-measurement using Technetium diethylenetriamine-pentaacetic acid[Tc-99 m-DTPA] at the point of the study time corresponding to disease duration. 21/30[70%] in G1 showed reduced GFR compared to 6/22[27.3%] in G2[P0.007] with 3.3 ± 0.5% annual reduction of GFR. Reduced GFR in G1 showed significant negative correlation with age[r = ?0.396, P = 0.005], MTX-cumulative dose[r = ?0.263, P = 0.049], MTX-intake duration[r = ?0.293, P = 0.031] and NSAID-intake duration[r = ?0.344, P = 0.014]. Low dose MTX has a slow cumulative effect on renal filtration manifested by GFR reduction over time that could be monitored by Tc-99 m DTPA.     

Hemophagocytic syndrome in a patient with rheumatoid arthritis

Abstract

A 76-year-old man with rheumatoid arthritis, who had been treated with oral prednisolone and methotrexate, presented with high fever and generalized fatigability. Laboratory data demonstrated marked pancytopenia, which we first regarded as a side effect of methotrexate, and leucovorin was administered with granulocyte-colony stimulating factor and transfusions. Because no recovery was recognized, however, bone marrow aspiration was performed, by which hemophagocytic syndrome was diagnosed. After corticosteroid pulse therapy was initiated, the patient’s symptoms were rapidly attenuated and laboratory data rapidly normalized.