解放军医学院学报2023，Vol.44Issue(11)：1212-1217,1223,7.DOI:10.12435/j.issn.2095-5227.2023.105
超声引导下局部注射氨甲蝶呤治疗剖宫产瘢痕妊娠的疗效及其预测研究
Ultrasound-guided injection of methotrexate in treatment of cesarean scar pregnancy:Outcomes and its prediction by β-HCG
摘要
Abstract
Background The rate of cesarean scar pregnancy(CSP)is increasing in these years,and there is no consensus on therapy.Objective To study the safety,efficacy and indications of ultrasound-guided local injection of methotrexate(MTX)in the treatment of CSP.Methods CSP patients treated in the First Medical Center of Chinese PLA General Hospital from 2008 to 2022 were retrospectively recruited.The clinical information and imaging data of patients,as well as the success rate of ultrasound guided local injection of MTX treatment before and after treatment were compared.Then ROC analysis of β-HCG prediction efficiency was performed.Results Of the included 107 CSP patients,103(96.26%)patients were treated successfully,among them 12(11.65%)cases received additional MTX injection.The treatment failed in 4(3.74%)patients with surgery intervention.β-HCG in the successful group was significantly lower than that in the failed group(Md[IQR]:12 636.00[2 009.00-28 138.00]IU/L vs 36 678.00[33 076.25-147 204.30]IU/L,P=0.004).Patients received multiple injections of MTX had higher β-HCG than those received single injection(Md[IQR]:9 157.00[1 390.80-24 888.60]vs 33 260.00[17 048.50-80 124.50],P=0.001).Only one patient had side effect and the liver transaminase elevated after therapy and improved several days later.ROC analysis showed that the AUC of treatment outcomes predicted by β-HCG was 0.927,and the AUC of the number of treatments(MTX injections)predicted by β-HCG was 0.792.Conclusion Ultrasound-guided injection of MTX is a safe and effective modality to treat CSP patients with lower β-HCG.The change trends of β-HCG and presence of clinical symptoms including vaginal bleeding and abdominal pain should be monitored,additional injection of MTX or surgery intervention could be performed if necessary.关键词
剖宫产瘢痕妊娠/超声引导下局部注射氨甲蝶呤/安全性/有效性Key words
cesarean scar pregnancy/ultrasound-guided injection of methotrexate/safety/efficacy分类
医药卫生引用本文复制引用
栗嘉楠,徐虹,刘勤,汪龙霞,李秋洋..超声引导下局部注射氨甲蝶呤治疗剖宫产瘢痕妊娠的疗效及其预测研究[J].解放军医学院学报,2023,44(11):1212-1217,1223,7.基金项目
北京市科委计划项目(Z171100001017141) （Z171100001017141）
军队后勤科研项目计划生育专项课题(23JSZ10) （23JSZ10）
