Gazvani M R, Baruah D N, Alfirevic Z, Emery S J
Reproductive Medicine, Liverpool Women's Hospital, UK.
Hum Reprod. 1998 Jul;13(7):1987-90. doi: 10.1093/humrep/13.7.1987.
In the search for a more potent alternative to a single i.m. injection of methotrexate for ectopic pregnancy, a randomized trial was organized. The efficacy of a combination of methotrexate and mifepristone was compared with methotrexate alone in the treatment of unruptured tubal pregnancies. The diagnosis of an unruptured tubal pregnancy was confirmed laparoscopically in 50 patients during a 2 year period. Women were randomized to receive a single i.m. injection of 50 mg/m2 methotrexate alone or a single dose of 600 mg oral mifepristone in combination with the same dose of methotrexate. Both treatment protocols were successful in achieving the resolution of unruptured ectopic pregnancy (18/25 in the methotrexate group and 22/25 in the combination group) following the initial intervention. A second injection was needed in four (16%) cases in the methotrexate group and in one (4%) case in the combination group. Overall, a complete resolution was achieved in 22/25 and 23/25 cases respectively. Unruptured ectopic pregnancy resolved faster in women given the combination of methotrexate and mifepristone compared to women given methotrexate only (P = 0.01). The effect of the methotrexate and mifepristone combination was more pronounced in women with higher human chorionic gonadotrophin concentrations.
为了寻找一种比单次肌内注射甲氨蝶呤治疗异位妊娠更有效的替代方法，组织了一项随机试验。将甲氨蝶呤和米非司酮联合用药的疗效与单独使用甲氨蝶呤治疗未破裂输卵管妊娠的疗效进行比较。在2年期间，通过腹腔镜检查确诊了50例未破裂输卵管妊娠患者。女性被随机分为两组，一组接受单次肌内注射50mg/m²甲氨蝶呤，另一组接受单次口服600mg米非司酮联合相同剂量的甲氨蝶呤。在初始干预后，两种治疗方案均成功实现了未破裂异位妊娠的消退（甲氨蝶呤组25例中有18例，联合组25例中有22例）。甲氨蝶呤组有4例（16%）需要第二次注射，联合组有1例（4%）需要第二次注射。总体而言，分别有22/25例和23/25例完全消退。与仅接受甲氨蝶呤治疗的女性相比，接受甲氨蝶呤和米非司酮联合治疗的女性未破裂异位妊娠消退更快（P = 0.01）。甲氨蝶呤和米非司酮联合治疗对人绒毛膜促性腺激素浓度较高的女性效果更明显。
