血清孕酮与HCG联合检测在异位妊娠药物保守治疗中的应用研究

摘要

目的 将血清孕酮(P)与绒毛膜促性腺激素(HCG)联合检测用以筛选进行药物保守治疗的异位妊娠患者.方法 选择药物保守治疗的异位妊娠63例,血清HCG均小于2 000 U/L,根据血清P水平将其分为A组(血清P＜20 nmol/L)35例；B组(血清P＞ 20 nmol/L)28例.所有病例均采用甲氨蝶呤(MTX)单次剂量肌注,监测血清HCG、血清P以及病灶大小.结果 A组35例均1次用药成功,成功率为100.00％；患者平均住院时间(7.5±2.4)d.B组1次用药成功5例,1次用药成功率17.86％,15例因血清HCG下降幅度缓慢,第2次使用MTX,其中有1例第3次使用MTX,总成功率71.43％；失败的8例手术治疗；患者平均住院时间(15.0 ±3.4)d.x2检验分析2组保守治疗成功率,P＜0.05,差异有统计学意义.t检验分析2组患者住院时间,P＜0.05,差异有统计学意义.结论 血清孕酮水平越低,药物保守治疗成功的可能性越高,即血清孕酮水平的高低可预示药物保守治疗的预后,可将血清孕酮与HCG联合应用以筛选进行药物保守治疗的异位妊娠患者.%Objective To screen suitable patients for medicine conservative treatment,monitoring serum progesterone and human chori-onic gonadotropin(HCG) in ectopic pregnancy were combined.Methods There were 63 cases with ectopic pregnancy received medicine conservative treatment,serum HCG less than 2 000 U/L.All patients were divided into group A with 35 cases (progesterone ＜ 20 nmol/L) and group B with 28 cases (progesterone ＞20 nmol/L).All of them were injected with MTX single dose.The level of HCG,progestin and lesions size were monitored.Results All patients in group A were successful with conservative treatment,average hospital stays were (7.5 ± 2.4)days.In group B,5 cases were successful with conservative treatment,the rate was 17.86％.Fifteen cases were injected with MTX another time because of HCG decreasing slowly,of which 1 case was injected with MTX at third time.Eight patients who failed to conservation treatment received operation,average stays were(15 ± 3.4)days and success rate was 71.43％.There was statistics difference on conservative treatment and average stays between 2 groups (P ＜ 0.05).Conclusion The level of serum progesterone is lower,the success rate is higher.The level of serum progesterone can screen patients by combination of monitoring serum progesterone and HCG in ectopic pregnancy.