目的 探讨甲氨蝶呤联合米非司酮治疗在改善异位妊娠生育需求患者内分泌功能及再次妊娠结局中的应用.方法 选取2013年9月至2016年9月确诊治疗的异位妊娠且有生育需求的患者200例,依据随机数表法分为联合组和单药组,每组100例.单药组患者给予1 mg/kg甲氨蝶呤肌内注射治疗,联合组患者在此基础上给予25 mg 米非司酮口服治疗,其中联合组依据甲氨蝶呤给药方法分为多次组和单次组,每组50例.单次组患者给药方法同单药组,多次组患者1 mg/kg甲氨蝶呤分3次每隔2 d肌内注射,采用放射免疫法检测血清人绒毛膜促性腺激素(β-HCG)水平,随访2年,统计分析所有患者治疗疗效和不良反应发生,治疗前,治疗后7、14 d的血清β-HCG水平和包块直径,治疗后6、12、18、24个月的再次妊娠结局情况.结果 多次组和单次组患者治疗有效率明显高于单药组,差异有统计学意义(P<0.05),但多次组和单次组患者上述指标水平基本相同,差异无统计学意义(P>0.05);多次组和单次组患者治疗后7、14 d的血清β-HCG水平及其复常时间明显低于单药组,差异有统计学意义(P<0.05),但多次组和单次组患者上述指标水平基本相同,差异无统计学意义(P>0.05);多次组和单次组患者治疗后7、14 d的包块直径及其消失时间明显低于单药组,差异有统计学意义(P<0.05),但多次组和单次组患者上述指标水平基本相同,差异无统计学意义(P>0.05);多次组患者不良反应发生率明显低于单次组和单药组,差异有统计学意义(P<0.05),但单次组和单药组患者上述指标水平基本相同,差异无统计学意义(P>0.05);多次组和单次组患者治疗后6、12、18个月再次正常妊娠率明显高于单药组,差异有统计学意义(P<0.05),但多次组和单次组患者上述指标水平和3组患者24个月再次正常妊娠率基本相同,差异无统计学意义(P>0.05).结论 甲氨蝶呤联合米非司酮治疗可有效提高异位妊娠生育需求患者的治疗疗效,及可有效改善患者的内分泌功能及再次妊娠结局,其中甲氨蝶呤多次给药方案具有更为良好的安全性且对临床疗效和再次妊娠结局无不良影响,值得临床作进一步推广.%Objective To investigate the effects of methotrexate combined with mifepristone in improving endocrine function and second pregnancy outcome in patients with ectopic pregnancy and fertility requirements.Methods Two hundred patients with ectopic pregnancy and fertility requirements who were diagnosed and treated in our hospital from September 2013 to September 2016 were enrolled in the study. According to random digital table,these patients were divided into combination treatment group and single drug treatment group,with 100 patients in each group.The patients in single drug treatment group were given methotrexate 1mg/kg by intramuscular injection,however,the patients in combination treatment group,on the basis of single drug treatment group,were given orally mifepristone 25mg. Moreover combination treatment group was redivided multiple medication group (n = 50) and single medication group (n = 50) according to the medictation method of amethopterin. The medication in single medication group was the same as that in single drug treatment group,however,the patients in multiple medication group were given methotrexate 1mg/kg by intramuscular injection for three times at an interval of 2 hours.Then the serum levels of villi gonadotropin(beta HCG) were detected by radio-immunity assay,with 2-year follow up,and the curative effects and incidence rate of adverse reactions were statistically analyzed.Moreover the serum levels of HCG ) and bag piece diameter before treatment and on 7d,14d after treatment as well as the status of secondary pregnancy outcome on 6m,12m,18m,24m after treatment were observed and compared among groups.Results The effective rate in multiple medication group and single medication group was significantly higher than that in single drug treatment group (P<0.05), however there was no significant difference between multiple medication group and single medication group (P >0.05). The serum levels of beta HCG on 7d,14d after treatment and time of recovering to normal state in multiple medication group and single medication group were significantly lower than those in single durg treatment group (P<0.05),but there were no significant differences between multiple medication group and single medication group (P>0.05). In addition the bag piece diameter and disappearing time on 7d,14d after treatment in multiple medication group and single medication group were significantly less than those in single drug treatment group (P<0.05),however there were no significant differences between multiple medication group and single medication group(P>0.05).Besides the incidence rate of adverse reactions in multiple medication group was significantly lower than that in single medication group and single drug treatment group (P<0.05),however there was no significant difference between single medication group and single drug treatment group (P >0.05).Moreover the secondary pregnancy rates on 6m,12m,18m after treatment in multiple medication group and single medication group were significantly higher than those in single drug treatment group (P <0.05),however there were no significant differences between multiple medication group and single medication group (P > 0. 05). Conclusion The methotrexate combined with mifepristone can effectively improve the therapeutic effects on ectopic pregnancy with fertility requirements,which can effectively improve the endocrine function of patients and secondary pregnancy outcome,in which, methotrexate multiple dedication scheme has better security and has no adverse effects on clinical curative effects and secondary pregnancy outcome,therefor,which is worth using widely in clinical practice.
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