Bottin P, Gnisci A, Crochet P, Butzbach P, Cravello L, Gamerre M, Agostini A
Service de gynécologie-obstétrique, hôpital La-Conception, 147, boulevard Baille, 13005 Marseille, France.
Service de gynécologie-obstétrique, hôpital La-Conception, 147, boulevard Baille, 13005 Marseille, France.
Gynecol Obstet Fertil. 2014 Jan;42(1):3-7. doi: 10.1016/j.gyobfe.2013.08.006. Epub 2013 Dec 3.
The purpose of this study was to evaluate the predictive value of early hCG changes on the risk of methotrexate (MTX) therapy failure for ectopic pregnancy.
This monocentric observational study compared the success of single-dose MTX therapy according to early hCG changes. Patients with a decrease of hCG value by at least 20% between day 1 and day 4 were followed up one month later only with an hCG concentration (group A, study protocol). The others patients were followed up with classic protocol, one time a week (group B).
Of the 91 patients treated, there were 29 (31.9%) patients in the group A and 62 (68.1%) in the group B. The overall success rate of MTX treatment was 89%. The success rate of single-dose MTX therapy was significantly increased in group A (29/29 (100%) vs 30/62 (48.4%), P<0.001). The rate of patients requiring surgical treatment was significantly lower in group A (0/29 vs 10/62 (16%), P=0.02) (Table 1).
The 20%-decrease cut-off between day 1 and day 4 appears to be a predictive factor to select patients with low failure rate after one MTX injection, allowing a less stringent follow-up.
本研究旨在评估早期人绒毛膜促性腺激素（hCG）变化对异位妊娠甲氨蝶呤（MTX）治疗失败风险的预测价值。
本单中心观察性研究根据早期hCG变化比较了单剂量MTX治疗的成功率。在第1天和第4天之间hCG值至少降低20%的患者仅在1个月后随访hCG浓度（A组，研究方案）。其他患者按照经典方案每周随访1次（B组）。
在接受治疗的91例患者中，A组有29例（31.9%），B组有62例（68.1%）。MTX治疗的总体成功率为89%。A组单剂量MTX治疗的成功率显著提高（29/29（100%）对30/62（48.4%），P<0.001）。A组需要手术治疗的患者比例显著更低（0/29对10/62（16%），P=0.02）（表1）。
第1天和第4天之间hCG值降低20%似乎是选择单次MTX注射后失败率低的患者的预测因素，从而可以进行不那么严格的随访。
