Study on predictive effect of serum beta human chorionic gonadotropin on unruptured tubal pregnancy treated by methotrexate
-
摘要:目的 探讨血清β-人绒毛膜促性腺激素（β-HCG）水平变化对甲氨蝶呤（MTX）治疗未破裂型输卵管妊娠效果的预测价值。方法 选取接受MTX治疗的197例未破裂型输卵管妊娠患者作为研究对象，根据MTX治疗结果的不同分为成功组（n=138）和失败组（n=59）。比较2组血清β-HCG水平变化，并应用受试者工作特征（ROC）曲线分析血清β-HCG水平预测MTX治疗效果的敏感度和特异度。结果 成功组β-HCG水平在第4天下降者占91.30%（126/138），高于失败组的20.34%（12/59），差异有统计学意义（P < 0.05）。2组给药第4、7天血清β-HCG水平以及β-HCG第1~4天变化率比较，差异均有统计学意义（P < 0.05）。ROC曲线分析结果显示，第1天β-HCG水平的特异度最高，第4天β-HCG水平的敏感度最高，综合分析显示第4天β-HCG水平对MTX治疗结果的预测价值较高。197例患者中，恶心呕吐者11例，转氨酶水平轻微上升者5例。结论 对于无症状且血流动力学稳定的未破裂型输卵管妊娠患者，基于血清β-HCG水平变化预测MTX的治疗效果是一种安全、有效的选择。
-
关键词:
- 异位妊娠 /
- 甲氨蝶呤 /
- β-人绒毛膜促性腺激素 /
- 受试者工作特征曲线 /
- 预测效能
Abstract:Objective To investigate predictive effect of serum beta human chorionic gonadotropin(β-HCG) on unruptured tubal pregnancy treated by methotrexate(MTX).Methods A total of 197 patients with unruptured tubal pregnancy treated with MTX were selected and divided into success group (n=138) and failure group (n=59) according to the results of MTX treatment. The changes of blood β-HCG levels in the two groups were compared, and the sensitivity and specificity of blood β-HCG in predicting therapeutic efficacy of MTX were analyzed by Receiver Operating Characteristic (ROC) curve.Results In the successful group, ratio of patients with the level of β-HCG decreased by 91.30%(126/138)on the fourth day was significantly higher than 20.34%(12/59) in those of the failure group(P < 0.05). The change rate of β-HCG ranging from the first day to the fourth day and β-HCG levels at 4 and 7 days after administration of two groups showed significant differences(P < 0.05). ROC curve analysis results showed that the β-HCG level on the 1st day was the highest in specificity, and was the highest on the 4th day in sensitivity. Comprehensive analysis showed that β-HCG level on the 4th day had a higher predictive value for MTX treatment outcomes. Out of 197 patients, 11 had nausea and vomiting, and 5 had slight increase of transaminase level.Conclusion For asymptomatic and stable ectopic pregnancy women in hemodynamics, it is a safe and effective and choice to predict the effect of MTX in the treatment of unruptured tubal pregnancy through the changes of serum β-HCG. -
-
表 1 2组患者一般资料比较(x±s)
组别 n 年龄/岁 孕次/次 停经时间/d 治疗前包块直径/mm 成功组 138 27.65±5.13 1.82±0.67 49.14±7.26 25.03±5.36 失败组 59 27.16±4.95 1.79±1.53 49.45±4.87 25.36±5.20 
下载: 导出CSV
表 2 2组血清β-HCG水平变化情况比较(x±s)
IU/L 组别 n β-HCG/(IU/L) 第1天 第4天 第7天 第1~4天变化率 第4~7天变化率 成功组 138 3 764.98±1 654.15 2 438.42±1 654.61 1 896.49±1 658.65 -35.92±5.75 -42.23±4.87 失败组 59 3 549.49±1 851.47 4 681.93±2 683.18* 3 351.15±1 513.67* 35.19±9.53* -25.51±7.12 β-HCG: β-人绒毛膜促性腺激素。与成功组比较, *P < 0.05。
下载: 导出CSV
表 3 不同时点血清β-HCG水平的ROC曲线分析结果
指标 AUC 95%CI 最佳临界值/(IU/L) 敏感度/% 特异度/% 阳性预测值/% 阴性预测值/% 第1天β-HCG 0.583 0.348~0.817 2 911.80 78.94 64.51 54.54 41.19 第4天β-HCG 0.795 0.669~0.921 3 947.71 86.36 54.54 77.65 86.73 第7天β-HCG 0.652 0.481~0.823 3 393.78 33.33 0 70.02 80.92
下载: 导出CSV
-
[1] 王玉东. 2016年英国皇家妇产科医师学会及早期妊娠学会《异位妊娠的诊断和管理》指南解读[J]. 中国实用妇科与产科杂志, 2017, 33(9): 916-919. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGSF201709013.htm [2] Chouinard M, Mayrand M H, Ayoub A, et al. Ectopic pregnancy and outcomes of future intrauterine pregnancy[J]. Fertil Steril, 2019, 112(1): 112-119. doi: 10.1016/j.fertnstert.2019.03.019
[3] KARAVANI G, GUTMAN-IDO E, HERZBERG S, et al. Recurrent tubal ectopic pregnancy management and the risk of a third ectopic pregnancy[J]. J Minim Invasive Gynecol, 2020, S1553-4650(20): 31172-31179. http://www.sciencedirect.com/science/article/pii/S1553465020311729
[4] BOYCHUK A V, KHLIBOVSKA O I, YAKYMCHUK Y B. Ectopic pregnancy and its long-term results[J]. Wiad Lek, 2020, 73(1): 139-144. doi: 10.36740/WLek202001127
[5] KHANI B, BEHNAMFAR F, TAGHIYAR L. Which protocol is better for treatment of ectopic pregnancy by methotrexate Single-dose or multiple-dose[J]. Adv Biomed Res, 2020, 9: 59. doi: 10.4103/abr.abr_5_20
[6] KINGSBURY B, SAM D, JEYASUDHA R, et al. Ectopic pregnancies: Catch them early, treat them wisely![J]. J Family Med Prim Care, 2020, 9(9): 4911-4918. doi: 10.4103/jfmpc.jfmpc_684_20
[7] 程燕, 任黔川. 中西医结合保守治疗血β-HCG值2000~5000 IU/L输卵管妊娠的疗效评价[J]. 西南医科大学学报, 2019, 42(6): 550-554. https://www.cnki.com.cn/Article/CJFDTOTAL-LXYB201906011.htm [8] 朱美丽. 米非司酮联合甲氨蝶呤治疗异位妊娠的临床疗效及其对血液流变学的影响[J]. 临床合理用药杂志, 2020, 13(33): 28-30. https://www.cnki.com.cn/Article/CJFDTOTAL-PLHY202033009.htm [9] 郭珺. 药物保守治疗与腹腔镜保守性手术治疗对异位妊娠患者保留输卵管的效果比较[J]. 中国民康医学, 2020, 32(2): 54-56. doi: 10.3969/j.issn.1672-0369.2020.02.022 [10] 王小玲. 血β人绒毛膜促性腺激素临界值对单剂量和多剂量甲氨蝶呤治疗异位妊娠临床疗效的影响[J]. 临床合理用药杂志, 2020, 13(1): 37-39. https://www.cnki.com.cn/Article/CJFDTOTAL-PLHY202001022.htm [11] 陈国强, 朱圣娇, 桂瑞丰, 等. 血清HCG、E2、P、CA125水平对早期异位妊娠与先兆流产诊断价值[J]. 中国计划生育学杂志, 2019, 27(8): 1051-1054. https://www.cnki.com.cn/Article/CJFDTOTAL-JHSY201908021.htm [12] 刘艳丽. 血清β-人绒毛膜促性腺激素、孕酮、癌抗原125联合彩色多普勒超声对异位妊娠早期诊断的研究[J]. 海南医学院学报, 2016, 22(7): 722-724, 728. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYY201607030.htm [13] WINTER T C. Ectopic pregnancy: Hemoperitoneum does not equate to tubal rupture[J]. Radiographics, 2021, 41(1): 318-320. doi: 10.1148/rg.2021200199
[14] 李秀娟. 血清β-HCG、孕酮、CK-MB比率、CA125联合阴道超声在早期异位妊娠诊断中的价值[J]. 中国实验诊断学, 2017, 21(12): 2075-2078. doi: 10.3969/j.issn.1007-4287.2017.12.010 [15] SINDIANI A M, ALSHDAIFAT E, OBEIDAT B, et al. The use of single dose methotrexate in the management of ectopic pregnancy and pregnancy of unknown location: 10 years' experience in a tertiary center[J]. Int J Womens Health, 2020, 12: 1233-1239. doi: 10.2147/IJWH.S279426
[16] SHAFIE M, ABBASZADEH M, SHARIFI F. Hyperpigmentation, severe alopecia, and six days of instability in a case of severe methotrexate hypersensitivity reaction[J]. DARU J Pharm Sci, 2021, 6: 1-5. doi: 10.1007/s40199-020-00379-0
[17] CIRIK D A, KINAY T, KESKIN U, et al. Success rates of single-dose methotrexate and additional dose requirements among women with first and previous ectopic pregnancies[J]. Int J Gynecol Obstet, 2016, 133(1): 49-52. doi: 10.1016/j.ijgo.2015.08.017
[18] RICHARDSON A. Medical management of ectopic pregnancy: a 10-year case series[J]. Hum Fertil, 2012, 15(3): 116-120. doi: 10.3109/14647273.2012.694571
[19] ALALADE A O, SMITH F J E, KENDALL C E, et al. Evidence-based management of non-tubal ectopic pregnancies[J]. J Obstet Gynaecol, 2017, 37(8): 982-991. doi: 10.1080/01443615.2017.1323852
[20] HENDRIKS E, ROSENBERG R, PRINE L. Ectopic pregnancy: diagnosis and management[J]. Am Fam Physician, 2020, 101(10): 599-606.
[21] LEVIN G, DIOR U, SHUSHAN A, et al. Early prediction of the success of methotrexate treatment success by 24-hour pretreatment increment in HCG and day 1-4 change in HCG[J]. Reprod Biomed Online, 2019, 39(1): 149-154. doi: 10.1016/j.rbmo.2019.02.005
[22] GOH A, KARINE P, KIRBY A, et al. Day 1 to day 4 serum hCG change in predicting single-dose methotrexate treatment failure for tubal ectopic pregnancies[J]. Eur J Obstet Gynecol Reprod Biol, 2020, 255: 105-110. doi: 10.1016/j.ejogrb.2020.10.036
[23] 谭晓艳. 彩超诊断宫外孕的应用价值分析[J]. 航空航天医学杂志, 2021, 32(2): 192-193. doi: 10.3969/j.issn.2095-1434.2021.02.038 -
期刊类型引用(10)
1. 赵婷婷，韩玮. 针对性护理对慢性胃溃疡合并高血压患者的效果观察. 贵州医药. 2024(02): 304-305 . 
百度学术
2. 洪丹妮，叶艳. 电子病床倾斜角度对消化内科患者舒适度的影响. 医疗装备. 2024(05): 118-120 . 百度学术
3. 杨照平. 云南白药辅治脑出血后应激性胃溃疡临床观察. 实用中医药杂志. 2024(06): 1096-1099 . 百度学术
4. 段小兵，王国涛，王冠军，胡国超. 血清高迁移率族蛋白Bl、白细胞介素-6与高血压性脑出血患者神经内镜微创术后神经功能及预后的关系. 成都医学院学报. 2024(04): 674-678 . 百度学术
5. 王攀，曾群. 中老年女性脑出血患者合并胃肠功能紊乱的多因素分析预测模型构建. 中国妇幼保健. 2024(20): 4045-4048 . 百度学术
6. 刘春军，严方方，杨哲，王宝锋. 瑞巴派特联合莫沙必利治疗应激性胃溃疡的效果分析. 中国实用医刊. 2024(23): 91-93 . 百度学术
7. 徐微，林小花，刘媛，何雪云，徐建光. 甘海胃康胶囊联合西药治疗气滞型老年胃溃疡临床研究. 新中医. 2023(17): 112-116 . 百度学术
8. 王磊，夏岩，张灯亮. 高血压脑出血患者术后出现消化道应激性溃疡出血的影响因素分析. 现代医学. 2023(10): 1464-1469 . 百度学术
9. 巩丹丹，马兴好. 高能量密度肠内营养支持对应激性胃溃疡患者胃粘膜修复的影响. 中国食物与营养. 2022(08): 53-56+62 . 百度学术
10. 田永建，姜伟峰，刘芳. 消化内镜联合瑞巴派特在胃溃疡出血中应用价值分析. 疾病监测与控制. 2022(05): 383-386 . 百度学术
其他类型引用(1)
计量
- 文章访问数: 367
- HTML全文浏览量: 206
- PDF下载量: 26
- 被引次数: 11
苏公网安备 32100302010246号
