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  • 闻笔伟△,俞晓敏△,顾仲毅,蔡圣芸,古航.血清β-人绒毛膜促性腺激素对甲氨蝶呤单次注射治疗异位妊娠结局的预测作用[J].第二军医大学学报,2021,42(3):270-274    [点击复制]
  • WEN Bi-wei△,YU Xiao-min△,GU Zhong-yi,CAI Sheng-yun,GU Hang*.Role of serum β-human chorionic gonadotropin in predicting the outcome of ectopic pregnancy treated with single-dose injection of methotrexate[J].Acad J Sec Mil Med Univ,2021,42(3):270-274   [点击复制]
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血清β-人绒毛膜促性腺激素对甲氨蝶呤单次注射治疗异位妊娠结局的预测作用
闻笔伟△,俞晓敏△,顾仲毅,蔡圣芸,古航
0
(海军军医大学(第二军医大学)长海医院妇产科, 上海 200433
共同第一作者
*通信作者)
摘要:
目的 评估血清β-人绒毛膜促性腺激素(β-hCG)对甲氨蝶呤(MTX)单次肌内注射治疗异位妊娠疗效的预测价值。方法 回顾性分析2010年1月1日至2018年12月31日在海军军医大学(第二军医大学)长海医院接受MTX单次肌内注射治疗的96例异位妊娠患者的临床资料。患者均接受MTX 50 mg/m2单次肌内注射方案,定期检测血清β-hCG水平。接受MTX单次注射治疗后随访血清β-hCG降至正常2次并且未再接受第2次MTX治疗或手术治疗者视为治疗成功。根据治疗结局将患者分为治疗成功组和治疗失败组,比较两组治疗前血清β-hCG水平。根据治疗前血清β-hCG水平将患者分为<1 000、1 000~1 999、2 000~2 999、≥ 3 000 mIU/mL组,比较各组间MTX单次注射治疗成功率。分析治疗后不同时间点血清β-hCG对预后的预测价值。结果 96例异位妊娠患者中,57例(59.4%)患者MTX单次注射治疗成功,39例(40.6%)失败。治疗成功组和治疗失败组治疗前血清β-hCG水平分别为343.00(212.50,720.00)和716.00(341.00,1 619.00)mIU/mL,差异有统计学意义(P=0.007)。随着治疗前血清β-hCG水平的升高,MTX单次注射治疗成功率逐步降低,但当治疗前β-hCG的水平<3 000 mIU/mL时,不同β-hCG水平亚组之间的成功率差异无统计学意义(P>0.05)。治疗后4 d血清β-hCG预测MTX单次注射治疗成功的AUC为0.80(95% CI 0.70~0.88,P<0.001),阈值为650 mIU/mL,灵敏度为91.2%,特异度为66.7%;治疗后7 d血清β-hCG预测MTX单次注射治疗成功的AUC为0.71(95% CI 0.58~0.82,P<0.001),阈值为103 mIU/mL,灵敏度为 42.9%,特异度为100.0%。治疗后4 d血清β-hCG ≤ 650 mIU/mL组的治疗成功率较>650 mIU/mL组高,差异有统计学意义(P<0.001);治疗后7 d血清β-hCG ≤ 103 mIU/mL组与>103 mIU/mL组治疗成功率差异无统计学意义(P=0.146)。结论 对于接受MTX单次注射治疗的异位妊娠患者,治疗成功者初始血清β-hCG水平较低,治疗后4 d血清β-hCG ≤ 650 mIU/mL可作为预测治疗成功的指标。
关键词:  人绒毛膜促性腺激素β亚单位  异位妊娠  甲氨蝶呤  单次注射
DOI:10.16781/j.0258-879x.2021.03.0270
投稿时间:2019-10-28修订日期:2021-02-25
基金项目:国家自然科学基金(31771667).
Role of serum β-human chorionic gonadotropin in predicting the outcome of ectopic pregnancy treated with single-dose injection of methotrexate
WEN Bi-wei△,YU Xiao-min△,GU Zhong-yi,CAI Sheng-yun,GU Hang*
(Department of Obstetrics and Gynaecology, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
Co-first authors.
* Corresponding author)
Abstract:
Objective To evaluate the value of serum β-human chorionic gonadotropin (β-hCG) for predicting the outcome of ectopic pregnancy treated with single-dose intramuscular injection of methotrexate (MTX). Methods The clinical data of 96 ectopic pregnancy patients treated with MTX intramuscular injection in Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 1, 2010 to Dec. 31, 2018 were retrospectively analyzed. All patients received MTX single-dose (50 mg/m2) intramuscular injection, and the serum β-hCG level was detected regularly. After receiving MTX single-dose intramuscular injection, the patients whose serum β-hCG levels were reduced to the normal twice, and who did not receive the second MTX treatment or surgical treatment were considered as successful. According to the treatment outcome, the patients were divided into treatment success group and failure group. The serum β-hCG levels of the two groups were compared before treatment. According to the pre-treatment serum β-hCG levels, they were divided into <1 000, 1 000-1 999, 2 000-2 999 and ≥ 3 000 mIU/mL groups, and the success rates of MTX single-dose injection were compared among the groups. The prognostic value of serum β-hCG was analyzed at different time points after treatment. Results Of the 96 ectopic pregnancy patients, 57 (59.4%) cases were treated successfully with MTX single-dose injection, and 39 (40.6%) cases were failed. The pre-treatment serum β-hCG levels were 343.00 (212.50, 720.00) and 716.00 (341.00, 1 619.00) mIU/mL in the treatment success group and failure group, respectively, with significant difference (P=0.007). With the increase of pre-treatment serum β-hCG level, the success rate of MTX single-dose injection decreased gradually; however, there were no significant differences in the success rates among the subgroups with different levels of β-hCG when the pre-treatment β-hCG level was lower than 3 000 mIU/mL (P>0.05). The area under curve (AUC) of serum β-hCG 4 days after treatment in predicting the success of MTX single-dose injection was 0.80 (95% confidence interval[CI] 0.70-0.88, P<0.001), the cut-off value was 650 mIU/mL, the sensitivity was 91.2%, and the specificity was 66.7%; the AUC of serum β-hCG 7 days after treatment in predicting the success of MTX single-dose injection was 0.71 (95% CI 0.58-0.82, P<0.001), the cut-off value was 103 mIU/mL, the sensitivity was 42.9%, and the specificity was 100.0%. The success rate in the group with serum β-hCG ≤ 650 mIU/mL 4 days after treatment was significantly higher than that in the group with serum β-hCG >650 mIU/mL (P<0.001), while the success rates were similar in the groups with serum β-hCG ≤ 103 mIU/mL and >103 mIU/mL 7 days after treatment (P=0.146). Conclusion For ectopic pregnancy patients receiving a single-dose injection of MTX, the initial β-hCG levels are lower in patients with successful treatment. Serum β-hCG ≤ 650 mIU/mL on day 4 after treatment could be a predictor of treatment success.
Key words:  human chorionic gonadotropin β unit  ectopic pregnancy  methotrexate  single-dose injection