氨甲蝶呤治疗输卵管妊娠的缓解时间：一项回顾性队列研究。
Time to resolution of tubal ectopic pregnancy following methotrexate treatment: A retrospective cohort study.
机构信息
Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia.
Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia.
出版信息
PLoS One. 2022 May 24;17(5):e0268741. doi: 10.1371/journal.pone.0268741. eCollection 2022.
OBJECTIVE
To determine the time to resolution of tubal ectopic pregnancy after methotrexate treatment.
METHODS
A 14-year retrospective cohort study was performed from 2004-2018 and assessed 216 women treated with single-dose methotrexate for tubal ectopic pregnancy. Women were treated using a single-dose protocol of intramuscular methotrexate (50mg/m2) for confirmed tubal ectopic pregnancy on ultrasound. Ectopic pregnancies were included if the ectopic pregnancy mass was <35mm, no evidence of rupture and no embryonic cardiac activity. Serum hCG was measured on day 1, 4 and 7 of treatment and then at standard weekly intervals until resolution. Where there was not a ≥15% decline in hCG from day 4 and day 7, a second dose of methotrexate was administered. The primary outcome was time to resolution (days), with serum hCG <5 IU/L considered resolved. The secondary outcome was need for rescue surgery.
RESULTS
Among women who did not proceed to surgery, the median time to resolution was 22 days (IQR 14,34). Time to resolution and need for rescue surgery increased with baseline hCG. When hCG was <1000 IU/L, the median was 20 days (IQR 13,29) but 34.5 days (IQR 22,48) with hCG >2000 IU/L. Early hCG trends were predictive of time to resolution and likelihood of rescue surgery; a hCG rise of >1000 IU/L between Days 1-4 increased time to resolution to 61 days (IQR 35,80) and an odds ratio of rescue surgery of 28.6 (95% C.I. 5.3,155.4).
CONCLUSION
The median time to resolution for ectopic pregnancies treated with methotrexate is 22 days and associated with baseline hCG levels. The predictive value of baseline hCG may be useful in clinical decision making and counselling women considering methotrexate for ectopic pregnancy.
目的
确定甲氨蝶呤治疗输卵管妊娠后消退的时间。
方法
这是一项回顾性队列研究，时间跨度为 2004 年至 2018 年，共评估了 216 名接受单次剂量甲氨蝶呤治疗输卵管妊娠的女性。对于经超声证实的输卵管妊娠，采用单次肌内注射甲氨蝶呤（50mg/m2）的单剂量方案进行治疗。如果宫外孕包块<35mm，无破裂证据且无胚胎心脏活动，则纳入宫外孕。治疗第 1、4 和 7 天测量血清 hCG，然后在标准每周间隔测量，直至消退。如果第 4 天和第 7 天 hCG 下降幅度<15%，则给予第二剂甲氨蝶呤。主要结局是消退时间（天），血清 hCG<5IU/L 认为消退。次要结局是需要手术抢救。
结果
在未进行手术的女性中，中位消退时间为 22 天（IQR 14，34）。消退时间和需要手术抢救的几率随着基线 hCG 增加而增加。当 hCG<1000IU/L 时，中位数为 20 天（IQR 13，29），但当 hCG>2000IU/L 时，中位数为 34.5 天（IQR 22，48）。早期 hCG 趋势可预测消退时间和手术抢救的可能性；第 1-4 天 hCG 升高>1000IU/L 会使消退时间延长至 61 天（IQR 35，80），手术抢救的几率比为 28.6（95%CI 5.3，155.4）。
结论
接受甲氨蝶呤治疗的宫外孕消退的中位时间为 22 天，与基线 hCG 水平相关。基线 hCG 的预测价值可能有助于临床决策，并为考虑甲氨蝶呤治疗宫外孕的女性提供咨询。
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