Lipscomb Gary H, Gomez Isabel G, Givens Vanessa M, Meyer Norman L, Bran Derita F
Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA.
Am J Obstet Gynecol. 2009 Mar;200(3):338.e1-4. doi: 10.1016/j.ajog.2008.12.006.
To determine whether yolk sac on transvaginal ultrasound was an independent predictor for single-dose methotrexate failure for tubal ectopic pregnancies.
Seven hundred sixty-six consecutive methotrexate-treated ectopic pregnancy patients were reviewed. After excluding 25 oral and 97 multidose methotrexate patients, 18 cornual, 4 cervical pregnancies, and 63 patients with ectopic cardiac activity, 559 study patients remained. Variables studied included age, gravidity, parity, previous ectopic pregnancy, serum human chorionic gonadotropin and progesterone levels, ectopic size, ectopic volume, body surface area, and yolk sac presence.
Sixteen of 73 (21.9%) patients with yolk sac failed treatment vs 36 of 486 (7.4%) patients without yolk sac (P = .0003). Other significant variables on single factor analysis were previous ectopic (P = .0005), human chorionic gonadotropin (P < .0001), and progesterone (P = .003). Only previous ectopic and human chorionic gonadotropin remained significant on logistic regression analysis.
The presence of a yolk sac, although a risk factor for failure of single-dose methotrexate in treatment of tubal ectopic pregnancy, is not an independent predictor.
确定经阴道超声检查时的卵黄囊是否为输卵管异位妊娠单剂量甲氨蝶呤治疗失败的独立预测因素。
回顾了766例连续接受甲氨蝶呤治疗的异位妊娠患者。排除25例口服甲氨蝶呤患者、97例多剂量甲氨蝶呤患者、18例宫角妊娠患者、4例宫颈妊娠患者以及63例有异位心搏的患者后，剩余559例研究对象。所研究的变量包括年龄、孕次、产次、既往异位妊娠史、血清人绒毛膜促性腺激素和孕酮水平、异位妊娠大小、异位妊娠体积、体表面积以及卵黄囊情况。
73例有卵黄囊的患者中有16例（21.9%）治疗失败，而486例无卵黄囊的患者中有36例（7.4%）治疗失败（P = 0.0003）。单因素分析中的其他显著变量为既往异位妊娠史（P = 0.0005）、人绒毛膜促性腺激素（P < 0.0001）和孕酮（P = 0.003）。逻辑回归分析显示，只有既往异位妊娠史和人绒毛膜促性腺激素仍具有显著性。
卵黄囊的存在虽然是输卵管异位妊娠单剂量甲氨蝶呤治疗失败的一个危险因素，但并非独立预测因素。
