甲氨蝶呤给药后 0-4 天血清人绒毛膜促性腺激素水平的变化预测输卵管妊娠治疗成功的趋势。
Trends in serum human chorionic gonadotropin levels 0-4 days after methotrexate administration for predicting tubal ectopic pregnancy treatment success.
机构信息
Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
出版信息
Int J Gynaecol Obstet. 2018 May;141(2):245-249. doi: 10.1002/ijgo.12419. Epub 2018 Jan 3.
OBJECTIVE
To evaluate serum human chorionic gonadotropin (HCG) levels 0-4 days after single-dose methotrexate administration for tubal ectopic pregnancy.
METHODS
The present retrospective study included women with tubal ectopic pregnancy treated by methotrexate at a tertiary hospital in Hong Kong, China, between January 1, 2007, and December 31, 2016. Patients were stratified serum HCG levels rose or fell from day 0-4 post-administration. Trends in day 0-4 serum HCG to predict treatment success were compared with that of day 4-7 serum HCG. The optimal drop in HCG was identified by receiver operating characteristic curve analysis.
RESULTS
There were 102 patients included. The positive predictive value (PPV) of day 0-4 serum HCG for treatment success was 91% (95% confidence interval [CI] 82-96), which is comparable to the current criterion of a 15% drop in day 4-7 serum HCG (PPV 91%, 95% CI 84-95). A 6% drop in day 0-4 serum HCG was the best predictor of treatment success (PPV 96%, 95% CI 86-99).
CONCLUSION
A drop in day 0-4 serum HCG provided earlier prognostic information and was not inferior to the current criterion.
目的
评估单次甲氨蝶呤给药后 0-4 天血清人绒毛膜促性腺激素（hCG）水平对输卵管妊娠的疗效。
方法
本回顾性研究纳入了 2007 年 1 月 1 日至 2016 年 12 月 31 日在中国香港一家三级医院接受甲氨蝶呤治疗的输卵管妊娠患者。根据治疗后 0-4 天血清 hCG 水平升高或下降，将患者分层。比较 0-4 天血清 hCG 预测治疗成功的趋势与 4-7 天血清 hCG 的预测趋势。通过受试者工作特征曲线分析确定 hCG 最佳下降幅度。
结果
共纳入 102 例患者。0-4 天血清 hCG 对治疗成功的阳性预测值（PPV）为 91%（95%置信区间[CI] 82-96），与目前 4-7 天血清 hCG 下降 15%的标准（PPV 91%，95%CI 84-95）相当。血清 hCG 下降 6%是治疗成功的最佳预测指标（PPV 96%，95%CI 86-99）。
结论
血清 hCG 下降幅度可提供更早的预后信息，且不劣于当前标准。
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