Tas Emre Erdem, Akcay Gulin Feykan Yegin, Avsar Ayse Filiz
Dr. Emre Erdem Tas, Department of Gynecology and Obstetrics, Yildirim Beyazit University, Ankara, Turkey.
Dr. Gulin Feykan Yegin Akcay, Department of Gynecology and Obstetrics, Ataturk Education and Research Hospital, Ankara, Turkey.
Pak J Med Sci. 2017 Jan-Feb;33(1):13-17. doi: 10.12669/pjms.331.11238.
To evaluate the success of systemic single-dose methotrexate (MTX) treatment in patients with ectopic pregnancy (EP) and to investigate factors related to treatment success.
This retrospective study had been performed in Yildirim Beyazit University between January 2010 and December 2015. Demographic and clinical characteristics, ultrasonografic findings, pretreatment serum β-human chorionic gonadotropin (β-hCG) and progesterone levels of 58 patients with EP were retrieved from hospital records retrospectively. The patients were grouped according to MTX treatment success (response failure).
Single-dose MTX-treatment was successful in 72.4% (42/58) of patients. The mean pretreatment β-hCG level was significantly lower in responders than in failures (2080 ± 2322 . 5707 ± 3885 IU/L, = 0.001), and 2678 IU/L was the most suitable cutoff to predict success (75% sensitivity, 73.8% specificity). Moreover, failure rate was 8.45 times more in group of patients whose β-hCG values were determined above the cutoff. The presence of fetal cardiac activity adversely affected treatment success (odds ratio = 12, = 0.004). Treatment success was not affected by past history of ectopic pregnancy, thickness of endometrium, progesterone value or presences of pseudosac and free pelvic fluid.
The success rate of single dose MTX in this study was 72.8 %, and we found that failure rate of MTX treatment was 8.45 times more in group of patients whose initial serum β-hCG values were above 2678 IU/L and 12 times more in patients with fetal cardiac activity.
评估全身单剂量甲氨蝶呤（MTX）治疗异位妊娠（EP）患者的成功率，并调查与治疗成功相关的因素。
本回顾性研究于2010年1月至2015年12月在耶尔德勒姆·贝亚齐特大学进行。回顾性地从医院记录中获取58例EP患者的人口统计学和临床特征、超声检查结果、治疗前血清β-人绒毛膜促性腺激素（β-hCG）和孕酮水平。根据MTX治疗成功与否（反应者与失败者）对患者进行分组。
单剂量MTX治疗在72.4%（42/58）的患者中成功。反应者的平均治疗前β-hCG水平显著低于失败者（2080±2322 vs. 5707±3885 IU/L，P = 0.001），2678 IU/L是预测成功的最合适临界值（敏感性75%，特异性73.8%）。此外，β-hCG值高于临界值的患者组失败率高8.45倍。胎儿心搏的存在对治疗成功有不利影响（优势比=12，P = 0.004）。治疗成功不受既往异位妊娠史、子宫内膜厚度、孕酮值或假孕囊及盆腔游离液的存在影响。
本研究中单剂量MTX的成功率为72.8%，我们发现初始血清β-hCG值高于2678 IU/L的患者组MTX治疗失败率高8.45倍，有胎儿心搏的患者失败率高12倍。
