MTX不同用药方法治疗异位妊娠后血β-HCG下降及其影响因素分析

目的:探讨不同的MTX给药方法治疗异位妊娠后血清β-HCG下降速度、幅度及其影响因素。方法:回顾性分析保守治疗异位妊娠112例,其中48例采用肌肉注射MTX20 mg,共用药5 d为A组,35例MXT50 mg单次肌注为B组,29例采用超声引导下,病灶局部注射MTX20 mg为C组。治疗后定期监测血清水平直至正常。结果:A组40例血清低于5 000 IU/L完全治愈,另外8例血清β-HCG高于5 000 IU/L失败。B组32例治愈,3例失败而手术。C组29例全部治愈。C组治疗后血清β-HCG下降至正常,明显短于A、B组。保守治疗前血清β-HCG水平较高者,治疗后降至正常所需时间较长。结论:保守治疗异位妊娠后连续监测血β-HCG水平极为重要。输卵管局部注射MTX可提高异位妊娠保守治疗成功率。

The reduction and its influential factors of serumβ- HCG levels after different conservative treatment for ectopic pregnancy

Objective:To analyze the reductive rate,extent and influential factors of serum β-HCG levels after different conservative treatment for ectopic pregnancy.Methods:Using a retrospective cohort,we collected 112 cases that received conservative treatment for ectopic pregnancy,including 48 cases treated with MTX 20mg im qd×5(group A),35 cases treated with single-dose of MTX 50mg in group B and 29 treated with local injection of MTX 20mg under the guidance of ultrasonography(group C) The levels of Serum β-HCG was surveyed every three days after conservative treatment until Serum β-HCG titer return to normal.Results:40 cases with Serum β-HCG levels less than 5 000 IU/L in group A cured completely,except 8 women with Serum β-HCG concentration higher than 5 000 IU/L.All 29 women of group C and 32 of 35 women of group B healed so.3 cases in group B developed and treated with surgery.The mean time for decline of serum β-HCG to normal levels was significantly shorter in group C than in group B and A.The higher serum β-HCG titers before conservative treatment related with longer time that drop to normal.Conclusion:Consecutive surveillance of serum β-HCG titers after conservative treatment is very important.Fallopian local injection of MTX may develop the successful rate of conservative treatment for ectopic pregnancy.