Erdem Mehmet, Erdem Ahmet, Arslan Murat, Oç Arzu, Biberoğlu Kutay, Gürsoy Rifat
Department of Obstetrics and Gynecology, Faculty of Medicine, Gazi University, Turkey.
Arch Gynecol Obstet. 2004 Dec;270(4):201-4. doi: 10.1007/s00404-003-0543-4. Epub 2003 Sep 3.
The objective of this study was to review our experience with single dose intramuscular methotrexate (MTX) for the treatment of ectopic pregnancy and to evaluate major confounding factors that relate to the success of therapy.
The selection criteria were patients who had a stable hemodynamic status and an ectopic gestational mass of <4 cm. on ultrasound. Patients were not excluded from MTX therapy either by a baseline serum beta-hCG titer or by the presence of fetal cardiac activity demonstrated on ultrasonography. Thirty- four of 86 patients diagnosed with ectopic pregnancy and treated with single-dose MTX between July 1999 and November 2001 were reviewed retrospectively.
The mean pre-treatment beta-hCG level was 2,490+/-2,912 mIU/ml. Twenty-two patients (73.3%) were successfully treated with a single-dose of MTX. Eight patients (26.6%) required a second dose 1 week after the first injection and 2 patients received three doses. Thirty of the 34 patients (88%) were successfully treated with MTX. The mean pre-treatment beta-hCG level was significantly lower in patients who were successfully treated with MTX than in patients who failed MTX therapy (1,932+/-2,361 mIU/ml vs. 6,955+/-2,690 mIU/ml respectively, p<0.05). The mean pre-treatment serum beta-hCG level was higher in patients who had a second MTX injection as compared to patients who were successfully treated with a single injection of MTX (3,272+/-3,551 mIU/ml vs. 1,280+/-2,273 mIU/ml respectively, p>0.05). The mean time to resolution of beta-hCG was 26.5 days (10 to 37 days) with MTX. All 3 patients who failed medical therapy had beta-hCG level >4,000 mIU/ml and 2 of them had positive fetal cardiac activity.
In conclusion, this study showed that medical treatment of ectopic pregnancy with systemic single-dose methotrexate seems to be an option for some patients with unruptured tubal pregnancy.
本研究的目的是回顾我们使用单剂量肌内注射甲氨蝶呤（MTX）治疗异位妊娠的经验，并评估与治疗成功相关的主要混杂因素。
入选标准为血流动力学稳定且超声检查显示异位妊娠包块<4 cm的患者。患者不因基线血清β-hCG滴度或超声检查显示有胎心活动而被排除在MTX治疗之外。回顾性分析了1999年7月至2001年11月期间86例诊断为异位妊娠并接受单剂量MTX治疗的患者中的34例。
治疗前β-hCG平均水平为2490±2912 mIU/ml。22例患者（73.3%）经单剂量MTX成功治疗。8例患者（26.6%）在首次注射1周后需要第二剂，2例患者接受了三剂。34例患者中有30例（88%）经MTX成功治疗。MTX治疗成功的患者治疗前β-hCG平均水平显著低于MTX治疗失败的患者（分别为1932±2361 mIU/ml和6955±2690 mIU/ml，p<0.05）。与单次注射MTX成功治疗的患者相比，接受第二次MTX注射的患者治疗前血清β-hCG平均水平更高（分别为3272±3551 mIU/ml和1280±2273 mIU/ml，p>0.05）。MTX治疗后β-hCG降至正常的平均时间为26.5天（10至37天）。所有3例药物治疗失败的患者β-hCG水平>4000 mIU/ml，其中2例有胎心活动阳性。
总之，本研究表明，对于一些未破裂输卵管妊娠患者，全身单剂量甲氨蝶呤药物治疗异位妊娠似乎是一种选择。
