Şükür Yavuz Emre, Koyuncu Kazibe, Seval Mehmet Murat, Çetinkaya Esra, Dökmeci Fulya
Department of Obstetrics and Gynecology, Ankara University School of Medicine, Cebeci Hospital, 06100, Dikimevi/Ankara, Turkey.
Arch Gynecol Obstet. 2017 Dec;296(6):1161-1165. doi: 10.1007/s00404-017-4527-1. Epub 2017 Sep 20.
To evaluate the performances of five different βhCG follow-up protocols after single-dose methotrexate therapy for tubal ectopic pregnancy (EP).
Data of patients who received single-dose methotrexate therapy for tubal EP at a university hospital between January 2011 and July 2016 were reviewed. A 'successful methotrexate treatment' was defined if the EP treated with no need for surgery. The performances of different protocols were tested by comparing with the currently used '15% βhCG decrease between days 4 and 7' protocol. The tested follow-up protocols were '20, 25%, and any βhCG decrease between days 0/1 and 7' and '20% and any βhCG decrease between days 0/1 and 4'.
Among the 96 patients evaluated, 12 (12.5%) required second dose. Totally, 91 (94.8%) patients treated successfully with no need for surgery. Four patients were operated within 4 days following the second dose. One patient who did not need second dose according to the standard follow-up protocol was operated on the 10th day due to rupture (specificity = 80%). Two protocols, namely '20% βhCG decrease between days 0/1 and 7' and 'any βhCG decrease between days 0/1 and 7' did not show statistically significant differences from the index protocol regarding the number of patients who should be assigned to 2nd dose.
'Any βhCG decrease between days 0/1 and 7' protocol may substitute the currently used one to decide second dose methotrexate in tubal EP management. Omitting 4th day measurement seems to be more convenient and cost effective.
评估单剂量甲氨蝶呤治疗输卵管异位妊娠（EP）后五种不同βhCG随访方案的效果。
回顾了2011年1月至2016年7月在某大学医院接受单剂量甲氨蝶呤治疗输卵管EP的患者数据。若EP治疗后无需手术，则定义为“甲氨蝶呤治疗成功”。通过与当前使用的“第4天至第7天βhCG下降15%”方案进行比较，测试不同方案的效果。测试的随访方案为“第0/1天至第7天βhCG下降20%、25%以及任何下降幅度”和“第0/1天至第4天βhCG下降20%以及任何下降幅度”。
在评估的96例患者中，12例（12.5%）需要第二剂药物。总共91例（94.8%）患者治疗成功，无需手术。4例患者在第二剂药物后4天内接受了手术。1例根据标准随访方案无需第二剂药物的患者在第10天因破裂接受了手术（特异性 = 80%）。两种方案，即“第0/1天至第7天βhCG下降20%”和“第0/1天至第7天βhCG任何下降幅度”，在应分配第二剂药物的患者数量方面与指标方案相比没有统计学显著差异。
“第0/1天至第7天βhCG任何下降幅度”方案可替代当前使用的方案，以决定输卵管EP管理中甲氨蝶呤的第二剂使用。省略第4天的测量似乎更方便且具有成本效益。
