血清β-人绒毛膜促性腺激素变化对甲氨蝶呤治疗未破裂型输卵管妊娠的预测效果

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。

     

    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.

     

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