Hoyos Luis R, Malik Mokerrum, Najjar Marvin, Rodriguez-Kovacs Javier, Abdallah Mazen, Vilchez Gustavo, Awonuga Awoniyi O
Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women's Hospital, 3990 John R, 7-Brush N, Mail Box 165, Detroit, MI, 48201, USA.
Reproductive Endocrinology and Infertility, Houston Fertility Services, Houston, TX, USA.
Arch Gynecol Obstet. 2017 Feb;295(2):375-381. doi: 10.1007/s00404-016-4229-0. Epub 2016 Nov 14.
Evaluate whether morbid obesity influenced resolution, number of doses or ultimately surgical management of tubal ectopic pregnancy (TEP) when treated with single-dose regimen methotrexate (SDR-MTX) capped at 100 mg.
Retrospective cohort study of patients with a diagnosis of TEP who underwent MTX treatment from 2000 to 2013. Patients were excluded if initial β-hCG <1000 mIU/mL, did not have β-hCG follow-up or were not treated with SDR-MTX. Per protocol, dose was administered at 50 mg/m with a capped maximum of 100 mg. Patients were divided based on their BMI (<40 and ≥40 kg/m). Demographic variables, β-hCG before treatment, maximum diameter of ectopic size, embryonic heart tones, decrease of β-hCG, need for additional MTX doses and surgery despite treatment were recorded and compared among the groups.
151 women were included in the study, 89.4% (135/151) non-morbidly obese and 10.6% (16/151) morbidly obese. No differences in age distribution, ethnicity, pre-treatment presence of embryonic heart tones, maximum diameter of ectopic size ≥35 mm and β-hCG ≥5000 mIU/ml were found. Following treatment, the proportion of patients with at least an 80% decrease in their β-hCG levels or need for surgery were similar, however, morbidly obese patients were significantly more likely [11/134 vs. 5/16, OR 5.1 (1.5-17.3, p = 0.015)] to require an additional MTX dose.
Among patients with TEP, morbidly obese patients were five times more likely to require an additional dose compared to non-morbidly obese when SDR-MTX capped at 100 mg was used for medical management.
评估在采用单次剂量方案甲氨蝶呤（SDR-MTX）且剂量上限为100mg治疗输卵管异位妊娠（TEP）时，病态肥胖是否会影响其消退情况、所需剂量数量或最终的手术治疗。
对2000年至2013年期间接受甲氨蝶呤治疗且诊断为TEP的患者进行回顾性队列研究。若初始β-hCG<1000mIU/mL、未进行β-hCG随访或未采用SDR-MTX治疗，则将患者排除。按照方案，以50mg/m²的剂量给药，最大剂量上限为100mg。根据患者的体重指数（BMI<40和≥40kg/m²）进行分组。记录并比较各组的人口统计学变量、治疗前的β-hCG、异位妊娠大小的最大直径、胚胎心音、β-hCG的下降情况、尽管接受了治疗仍需要额外甲氨蝶呤剂量及手术的情况。
151名女性纳入研究，其中89.4%（135/151）非病态肥胖，10.6%（16/151）病态肥胖。在年龄分布、种族、治疗前胚胎心音的存在情况、异位妊娠大小最大直径≥35mm以及β-hCG≥5000mIU/ml方面未发现差异。治疗后，β-hCG水平至少下降80%或需要手术的患者比例相似，然而，病态肥胖患者更有可能[11/134 vs. 5/16，比值比5.1（1.5 - 17.3，p = 0.015）]需要额外一剂甲氨蝶呤。
在采用剂量上限为100mg的SDR-MTX进行药物治疗的TEP患者中，病态肥胖患者需要额外一剂甲氨蝶呤的可能性是非病态肥胖患者的五倍。
