Mirbolouk Fariba, Yousefnezhad Azadeh, Ghanbari Atefeh
Department of Obstetrics and Gynecology, Guilan University of Medical Sciences, Rasht, Iran.
Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran.
Iran J Reprod Med. 2015 Jun;13(6):351-4.
Nowadays, The first step in treatment of ectopic pregnancy (EP) is medical treatment. Medical treatment with methotrexate (MTX) for EP is safe and effective method without the risks associated with the surgical procedure. But there are controversies between studies for which patients will respond better to medical treatment.
The aim of the present study was to investigate the predictive factors of success or failure of treatment of EP with single dose MTX.
In this retrospective study, records of 370 patients who were treated for tubal EP with single dose of MTX were reviewed during four years. Patients were divided into two groups; the first group or "success group" are the patients who were successfully treated with MTX. The second group or "failure group" consist the patients who did not respond to the MTX therapy. The week of gestation, size and location of EP and β-hCG level were compared between groups.
Of 370 patients, 285 (77.1%) were successfully treated with MTX. 85 patients (22.9%) required surgery after a mean of 5.4 (range 2-15) days. Day-1 beta- human chorionic gonadotropin (β-hCG) and fall in β-hCG between day 1 and day 4 were the best predictors for single dose MTX treatment success. The cutoff value of initial β-hCG with the success treatment results was found to be 1375 IU/mL there was no statistical difference between groups about week of gestation, size and location of EP.
The results showed that patients who have β-hCG levels below 1375 and the number of cases with decreasing β-hCG level on day 4 are the good candidates for medical treatment.
如今，异位妊娠（EP）治疗的第一步是药物治疗。甲氨蝶呤（MTX）用于EP的药物治疗是一种安全有效的方法，没有与外科手术相关的风险。但对于哪些患者对药物治疗反应更好，各研究之间存在争议。
本研究的目的是探讨单剂量MTX治疗EP成功或失败的预测因素。
在这项回顾性研究中，回顾了四年期间370例接受单剂量MTX治疗输卵管EP患者的记录。患者分为两组；第一组或“成功组”是接受MTX成功治疗的患者。第二组或“失败组”包括对MTX治疗无反应的患者。比较两组之间的孕周、EP的大小和位置以及β-hCG水平。
370例患者中，285例（77.1%）接受MTX成功治疗。85例患者（22.9%）在平均5.4天（范围2 - 15天）后需要手术。第1天的β-人绒毛膜促性腺激素（β-hCG）以及第1天和第4天之间β-hCG的下降是单剂量MTX治疗成功的最佳预测指标。成功治疗结果的初始β-hCG临界值为1375 IU/mL，两组在孕周、EP的大小和位置方面无统计学差异。
结果表明，β-hCG水平低于1375且第4天β-hCG水平下降的患者是药物治疗的良好候选者。
