Inal Zeynep Ozturk, Inal Hasan Ali
Konya Education and Research Hospital, Department of Gynecology, Konya, Turkey.
Geburtshilfe Frauenheilkd. 2018 Jan;78(1):70-77. doi: 10.1055/s-0043-122151. Epub 2018 Jan 22.
To compare the results of expectant management, single and multidose methotrexate (MTX) and surgical management of ectopic pregnancy (EP).
In this retrospective cohort study, the original files of 233 patients who were treated for EP between May 2009 and December 2016 were analyzed. The patients were assigned to the following groups based on the applied treatment methods: Group 1, expectant management (n = 24), Group 2, single-dose MTX (n = 144), Group 3, multiple-dose MTX (n = 25), and Group 4, surgical intervention (n = 40). The following parameters were recorded and assessed: sociodemographic characteristics, pelvic ultrasonography findings (gestational sac, ectopic mass appearance, positive fetal cardiac activity), serum beta-human chorionic gonadotropin (β-hCG) levels on Day 0, Day 4, and Day 7, and surgical procedures in women that underwent surgical interventions.
The sociodemographic characteristics were similar in all four groups. The percentage of ectopic mass and positive fetal cardiac activity was greater and the diameter of the mass was larger in Group 4 than in the other groups. The β-hCG values on Day 0, Day 4, and Day 7 were statistically different between the groups (p < 0.001). The cutoff value for the β-hCG change for EP resolution was 18% between Day 0 and Day 4 (AUC = 0.726, p < 0.001) and 15% between Day 4 and Day 7 (AUC = 0.874, p < 0.001). The probability of the requirement for an additional dose of MTX was 0.78 (95% CI 0.71 - 0.87; p < 0.001) times lower in patients who had a > 18% decrease in β-hCG levels from Day 0 to Day 4 in comparison to those who had a decrease < 18% from Day 0 to Day 4. The probability of the requirement for an additional dose of MTX was 1.64 (95% CI 1.25 - 2.16; p < 0.001) times greater in patients whose reduction in β-hCG levels from Day 4 to Day 7 was < 15% in comparison to those who had > 15% reduction from Day 4 to Day 7.
Additional dose requirements for patients with EP may be predicted early in the changes in β-hCG levels between Day 0 and Day 4. Further prospective studies are required to elucidate this issue.
比较异位妊娠（EP）的期待治疗、单剂量和多剂量甲氨蝶呤（MTX）治疗以及手术治疗的效果。
在这项回顾性队列研究中，分析了2009年5月至2016年12月期间接受EP治疗的233例患者的原始病历。根据所采用的治疗方法，将患者分为以下几组：第1组，期待治疗（n = 24）；第2组，单剂量MTX治疗（n = 144）；第3组，多剂量MTX治疗（n = 25）；第4组，手术干预（n = 40）。记录并评估以下参数：社会人口统计学特征、盆腔超声检查结果（妊娠囊、异位包块表现、胎儿心搏阳性）、第0天、第4天和第7天的血清β-人绒毛膜促性腺激素（β-hCG）水平，以及接受手术干预的女性的手术过程。
四组患者的社会人口统计学特征相似。第4组的异位包块和胎儿心搏阳性的比例更高，包块直径更大。各组之间第0天、第4天和第7天的β-hCG值存在统计学差异（p < 0.001）。EP消退时β-hCG变化的截断值在第0天至第4天为18%（AUC = 0.726，p < 0.001），在第4天至第7天为15%（AUC = 0.874，p < 0.001）。与第0天至第4天β-hCG水平下降<18%的患者相比，第0天至第4天β-hCG水平下降>18%的患者需要额外一剂MTX的概率低0.78倍（95%CI 0.71 - 0.87；p < 0.001）。与第4天至第7天β-hCG水平下降>15%的患者相比，第4天至第7天β-hCG水平下降<15%的患者需要额外一剂MTX的概率高1.64倍（95%CI 1.25 - 2.16；p < 0.001）。
可在第0天至第4天β-hCG水平变化的早期预测EP患者对额外剂量的需求。需要进一步的前瞻性研究来阐明这一问题。
