治疗前β-人绒毛膜促性腺激素变化对甲氨蝶呤治疗异位妊娠结局的预测分析

Value of pre-treatment β-hCG changes for predicting outcome of methotrexate treatment in patients with ectopic pregnancies

摘要:

目的 探讨用药前血清β-人绒毛膜促性腺激素(β-human chorionic gonadotropin, β-hCG)变化对异位妊娠（ectopic pregnancy, EP）药物治疗成功率的预测作用。方法 回顾性分析上海市长宁区妇幼保健院114例采用甲氨蝶呤（methotrexate, MTX）单次肌内注射方案的EP患者的临床资料，根据治疗结局分为成功组（69例）和失败组（45例），收集和分析两组患者基线信息和治疗结局，并运用ROC曲线分析用药前血清β-hCG变化情况对治疗结果的预测效能。结果 接受MTX单剂量肌注方案的114例EP患者中，69例治疗成功，45例治疗失败，成功率60.5%。成功组中用药前血清β-hCG下降的46例（66.7%），明显高于失败组（P=0.000）；成功组中用药前血清β-hCG下降比值（R用药前）明显大于失败组（P=0.001）。ROC曲线分析示，相比于β-hCG0D，R用药前对治疗成功率的预测效能更强，曲线下面积为0.766，最佳截断值为-6.5%，灵敏度与特异度分别为84.4%和60.9%。结论 对于接受MTX单次肌注方案的EP患者，治疗结局与用药前血清β-hCG值及变化幅度有关，用药前血清β-hCG下降比值可有效预测治疗成功率，指导患者分层管理。

Abstract:

Objective To investigate the value of pre-treatment β-hCG changes in predicting the outcome of methotrexate(MTX) treatment in patients with ectopic pregnancy(EP). Methods Clinical data of 114 patients with EP treated by single-dose MTX injection in Shanghai Changning Maternity and Infant Health Hospital were retrospectively analyzed. According to the outcomes of MTX treatment, 114 patients were classified into success group and failure group. The influencing factors of MTX treatment outcomes were analyzed. The efficacy of pre-treatment β-hCG changes for predicting MTX treatment outcome was evaluated with ROC curve. Results Among 114 EP patients treated with MTX, there were 69 cases in success group and 45 cases in failue group. The proportion of patients with decreased β-hCG before treatment in the success group(46/69, 66.7%) was significantly higher than that in the failure group(14/45, 31.1%, P=0.000). The ratio of serum β-hCG decrease before treatment(RBT) in the success group was significantly greater than that of the failure group(P=0.001). ROC analysis showed that the area under the curve(AUC) of RBT in predicting sussessful treatment outcome was 0.766, and the cut-off value was -6.5%, with a sensitivity and specificity of 84.4% and 60.9%, respectively. Conclusion For EP patients treated by single-dose MTX injection, the treatment outcome is significantly associated with pre-treatment β-hCG changes, and the ratio of serum β-hCG change before treatment(RBT) may be used as a predictor for treatment success in EP patients treated by single-dose MTX.