我们能预测甲氨蝶呤治疗异位妊娠的时限吗？

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OBJECTIVE

目的

To date, there is no method to predict time to resolution (TTR) of ectopic pregnancy (EP) after methotrexate (MTX). This study assesses whether patient- and pregnancy-specific variables can predict TTR.

到目前为止，没有方法可以预测甲氨蝶呤（MTX）治疗异位妊娠（EP）后的缓解时间（TTR）。本研究评估患者和妊娠特定变量是否可以预测TTR。

MATERIALS AND METHODS

材料与方法

Patients from 2019-2023 who received MTX to treat an EP or a pregnancy of unknown location (PUL) suspicious for EP based on abnormally trending hCG levels, uterine aspiration results, and/or ultrasound findings were included. HCG levels were obtained on day of MTX, and 4 and 7 days after MTX. An hCG decrease of ≥15% was considered adequate. Resolution was defined as hCG <1. Patients in whom a 15% hCG decrease was not detected were given additional dose(s) with continued monitoring.

Chi-square and Fisher’s exact tests were used to compare patient traits. Correlation between variables was assessed using Kruskal’s Wallis test. TTR was assessed using multivariate regression.

纳入2019—2023年接受MTX治疗EP或者基于hCG水平异常趋势、子宫抽吸结果和/或超声检查结果怀疑为EP的未知位置妊娠（PUL）的患者。在MTX治疗当天以及MTX治疗后的第4天和第7天获取hCG水平。hCG减少≥15%被认为是充分的。解决定义为hCG <1。在未检测到15%的hCG减少的患者中，会给予额外剂量并继续监测。

我们使用了卡方检验和Fisher精确检验来比较患者的特征。使用克鲁斯卡尔的沃利斯检验评估变量之间的相关性。使用多元回归分析评估解决时间（TTR）。

RESULTS

结果

Of 68 patients who received MTX, 10 conceived unassisted, 40 used ovulation induction, and 18 underwent embryo transfer. Thirty-seven patients (54.4%) required 1 dose of MTX, 28 (41.2%) required 2 doses, and 3 (4.4%) required 3 doses. Medians of BMI, MTX dosage, and hCG levels were significantly different between groups (Table 1).

Patients requiring multiple doses had higher day 1 hCG levels than those requiring 1 dose (p=0.02). Those who required 3 doses had higher day 1 hCG levels than those requiring 1 (p=0.03) or 2 doses (p=0.04).

There was a significant difference in TTR for those receiving 1 vs. 2 doses (median 25 vs. 38 days, p=0.01), but no significant differences in TTR between those requiring 1 vs. 3 doses or 2 vs. 3 doses. Multivariate regression revealed a weak relationship between day 1 hCG and TTR (HR 1.001, p=0.048).

在接受MTX治疗的68名患者中，10人自然受孕，40人使用诱导排卵，18人进行胚胎移植。37名患者（54.4%）需要1剂MTX，28名（41.2%）需要2剂，3名（4.4%）需要3剂。BMI、MTX剂量和hCG水平的中位数在各组之间有显著差异（表1）。

需要多剂MTX的患者第一天的hCG水平比需要一剂的患者更高（p=0.02）。需要3剂的患者第一天的hCG水平比需要1剂（p=0.03）或2剂（p=0.04）的患者更高。

接受1剂和2剂MTX的患者的解决时间存在显著差异（中位数分别为25天和38天，p=0.01），但是需要1剂与3剂或2剂与3剂的患者之间的解决时间没有显著差异。多元回归分析显示，第一天的hCG水平与TTR的关系较弱。

CONCLUSIONS

结论

Patients requiring 2 doses of MTX for treatment of EP had longer TTR than patients requiring 1 dose. Patients with higher BMIs and day 1 hCG levels were more likely to require additional doses.

需要两剂MTX治疗异位妊娠的患者的解决时间比只需要一剂的患者更长。BMI较高和第一天hCG水平较高的患者更可能需要额外的剂量。

IMPACT STATEMENT

影响声明

Patients receiving MTX may have longer TTR if additional doses are required.

如果需要额外的剂量，接受甲氨蝶呤的患者可能有更长的TTR时间。

文章来源：

CAN WE PREDICT TIME TO RESOLUTION OF ECTOPIC PREGNANCIES TREATED WITH METHOTREXATE?Pearson, Hillary et al.Fertility and Sterility, Volume 120, Issue 4, e317