甲氨蝶呤联合米非司酮治疗异位妊娠效果的回顾性队列研究

刘翌; 杨志勇; 王齐尔; 谢运飞

doi:10.6039/j.issn.1001-0408.2023.04.17

您当前的位置：

首页 >

文章列表页 >

甲氨蝶呤联合米非司酮治疗异位妊娠效果的回顾性队列研究

药物与临床 | 更新时间：2023-02-24

- 甲氨蝶呤联合米非司酮治疗异位妊娠效果的回顾性队列研究
- Retrospective cohort study on the efficacy of methotrexate combined with mifepristone in the treatment of ectopic pregnancy
- 中国药房 2023年34卷第4期页码：471-475
- 作者机构：
  
  1.成都大学附属医院药剂科，成都　610081
  2.成都大学附属医院妇产科，成都　610081
  3.四川省医学科学院/四川省人民医院核医学科，成都　610072
- 作者简介：
  
  主管药师，硕士。研究方向：临床药学。电话：028-86432423。E-mail：liuyi21223@sina.com
  主管药师，博士。研究方向：临床药学、中药药理学、放射药学。电话：028-87393445。E-mail：xyfsub@126.com
- 基金信息：
  
  四川省医学会青年创新科研课题(Q21066);成都药学会赞邦药学科研基金项目(202103)
- DOI：10.6039/j.issn.1001-0408.2023.04.17
  中图分类号： R97;R714.22
- 纸质出版日期：2023-02-28，
  
  收稿日期：2022-09-01，
  
  修回日期：2022-12-19，
扫描看全文
刘翌,杨志勇,王齐尔等.甲氨蝶呤联合米非司酮治疗异位妊娠效果的回顾性队列研究 ^Δ[J].中国药房,2023,34(04):471-475.

LIU Yi,YANG Zhiyong,WANG Qier,et al.Retrospective cohort study on the efficacy of methotrexate combined with mifepristone in the treatment of ectopic pregnancy[J].ZHONGGUO YAOFANG,2023,34(04):471-475.
刘翌,杨志勇,王齐尔等.甲氨蝶呤联合米非司酮治疗异位妊娠效果的回顾性队列研究 ^Δ[J].中国药房,2023,34(04):471-475. DOI： 10.6039/j.issn.1001-0408.2023.04.17.

LIU Yi,YANG Zhiyong,WANG Qier,et al.Retrospective cohort study on the efficacy of methotrexate combined with mifepristone in the treatment of ectopic pregnancy[J].ZHONGGUO YAOFANG,2023,34(04):471-475. DOI： 10.6039/j.issn.1001-0408.2023.04.17.

摘要

目的

探讨甲氨蝶呤（MTX）注射液联合米非司酮片治疗异位妊娠的效果。

方法

采用回顾性队列研究方法，收集2013年1月1日－2021年12月31日在成都大学附属医院就诊的异位妊娠患者资料。单独给予MTX注射液的为对照组，给予MTX注射液联合米非司酮片的为暴露组。采用倾向性评分匹配（PSM）法均衡两组基线变量，比较匹配后队列的结局指标。

结果

纳入125例患者，其中对照组68例，暴露组57例。经PSM后，各组有46例匹配成功。暴露组和对照组的治疗有效率分别为73.91%和63.04%、药品不良反应（ADR）发生率分别为21.74%和13.04%，均无显著差异（

＞0.05）。两组患者组内治疗前后血清

-HCG值对比均显著下降（

＜0.05），但两组患者治疗后血清

-HCG值及其恢复正常的时间、再次妊娠、再次异位妊娠、再次宫内妊娠的间隔时间均无显著差异（

＞0.05）。暴露组的B超妊娠包块平均直径治疗前后差值、临床症状缓解时间和住院时间均显著大于对照组（

＜0.05），但住院期间的药品费用和住院总费用并未显著增加（

＞0.05）。MTX单剂方案组和多剂方案组的治疗有效率、ADR发生率无显著差异（

＞0.05），单剂方案组的住院时间、药品费用、住院总费用均显著少于多剂方案组（

＜0.05）。

结论

MTX注射液联合或不联合米非司酮片都能有效治疗异位妊娠，有效性和安全性相当。联合治疗可以促进包块缩小，且对住院费用和再次妊娠情况无明显影响。MTX单剂方案和多剂方案治疗效果相当，但多剂方案增加了住院时间和住院费用。

Abstract

OBJECTIVE

To investigate the efficacy of Methotrexate （MTX） injection combined with Mifepristone tablets in the treatment of ectopic pregnancy.

METHODS

A retrospective cohort study method was used to collect data on patients with ectopic pregnancy who visited the Affiliated Hospital of Chengdu University from January 1， 2013 to December 31， 2021. Control group was given MTX injection alone， and exposure group was given MTX injection combined with Mifepristone tablets. Baseline variables were balanced between the two groups using a propensity score matching （PSM）， and the outcomes of the matched cohorts were compared.

RESULTS

A total of 125 patients were included， involving 68 in the control group and 57 in the exposure group. After PSM， 46 cases in each group were successfully matched. There was no significant difference in the treatment response rate and the incidence of adverse drug reaction （ADR） between the exposure group and the control group， which were 73.91% and 63.04%， 21.74% and 13.04% （

＞0.05）. Compared with before treatment， serum levels of

-HCG were all significantly decreased in 2 groups after treatment （

＜0.05）； there was no significant difference in the serum level of

-HCG after treatment， the time to return to normal， the interval time of second pregnancy， second ectopic pregnancy and second intrauterine pregnancy between 2 groups （

＞0.05）. The mean diameter difference of B-ultrasound pregnancy mass before and after treatment， duration of clinical symptom remission and length of hospital stay in the exposure group were significantly higher than those in the control group （

＜0.05）， but drug costs during hospitalization and total hospitalization costs were not significantly increased （

＞0.05）. There were no significant difference between single-dose group and multi-dose group of MTX in the treatment response rate and the incidence of ADR （

＞0.05）. The hospitalization time， drug cost and total cost of the single dose group were significantly less than those of the multi-dose group （

＜0.05）.

CONCLUSIONS

MTX injection combined with or without Mifepristone tablet can both effectively treat ectopic pregnancy， with comparable efficacy and safety. MTX single-dose regimen is similar to the multi-dose regimen in efficacy， but the multi-dose regimen increases the hospital stay and hospitalization costs.

关键词

甲氨蝶呤米非司酮倾向性评分匹配异位妊娠再次妊娠疗效经济性

Keywords

mifepristonepropensity score matchingectopic pregnancysecond pregnancyefficacyeconomy

references

乐杰. 妇产科学[M].6版. 北京：人民卫生出版社，2004：1.

BARNHART K，COUTIFARIS C，ESPOSITO M. The pharmacology of methotrexate[J]. Expert Opin Pharmacother，2001，2（3）：409-417.

刘尧芳，黄薇. 甲氨蝶呤在异位妊娠保守治疗中的应用[J]. 中国实用妇科与产科杂志，2006，22（11）：869-872.

PO L，THOMAS J，MILLS K，et al. Guideline No. 414：management of pregnancy of unknown location and tubal and nontubal ectopic pregnancies[J]. J Obstet Gynaecol Can，2021，43（5）：614-630.

National Institute for Health and Clinical Excellence. Ectopic pregnancy and miscarriage：diagnosis and initial management：NICE guideline NG126[DB/OL].[2022-08-06].https：//www.nice.org.uk/guidance/ng126https://www.nice.org.uk/guidance/ng126.

American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins-Gynecology. ACOG practice bulletin No. 193：tubal ectopic pregnancy[J]. Obstet Gynecol，2018，131（3）：e91-e103.

Royal College of Obstetricians and gynaecologists. Diag-nosis and management of ectopic pregnancy：green-top guideline No.21[DB/OL].[2022-08-06].https：//www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg21https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg21.

王玉东，陆琦. 输卵管妊娠诊治的中国专家共识[J]. 中国实用妇科与产科杂志，2019，35（7）：780-787.

陈志华，吴杰，田文艳，等. 输卵管间质部妊娠诊治的中国专家共识：2022年版[J]. 中国实用妇科与产科杂志，2022，38（3）：290-295.

应丽英，崔雪娜，丁洪琼. 甲氨蝶呤联合米非司酮治疗异位妊娠疗效及对血清人绒毛膜促性腺激素、癌抗原125、子宫内膜厚度的影响[J]. 中国基层医药，2021，28（3）：415-420.

HAJENIUS P J，MOL F，MOL B J，et al. Interventions for tubal ectopic pregnancy[J]. Cochrane Database Syst Rev，2007，2007（1）：CD000324.

SONG H D，CHEN S L，HE J X，et al. Combined use of methotrexate and mifepristone for ectopic pregnancy mana-gement：a meta-analysis[J]. J South Med Univ，2006，26（12）：1815-1817.

VARMA R，GUPTA J. Tubal ectopic pregnancy[J]. BMJ Clin Evid，2012，2012：1406.

GAZVANI M R，BARUAH D N，ALFIREVIC Z，et al. Mifepristone in combination with methotrexate for the medical treatment of tubal pregnancy：a randomized，controlled trial[J]. Hum Reprod，1998，13（7）：1987-1990.

GROSE E，WILSON S，BARKUN J，et al. Use of propensity score methodology in contemporary high-impact surgical literature[J]. J Am Coll Surg，2020，230（1）：101-112.e2.

WEITZEN S，LAPANE K L，TOLEDANO A Y，et al. Principles for modeling propensity scores in medical research：a systematic literature review[J]. Pharmacoepidemiol Drug Saf，2004，13（12）：841-853.

SVIRSKY R，ROZOVSKI U，VAKNIN Z，et al. The safety of conception occurring shortly after methotrexate treatment of an ectopic pregnancy[J]. Reprod Toxicol，2009，27（1）：85-87.

彭小灵. 不同甲氨蝶呤应用方案联合米非司酮治疗异位妊娠的对照分析[J]. 中国医药科学，2020，10（1）：94-96，156.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

玛巴洛沙韦治疗流行性感冒的快速卫生技术评估

利那洛肽治疗便秘型肠易激综合征的快速卫生技术评估

心血管外科手术患者预防用抗菌药物的临床评价

格列喹酮对比格列本脲治疗2型糖尿病有效性和经济性的系统评价

基于马尔可夫模型比较丙戊酸钠、托吡酯和苯妥英钠治疗癫痫的经济性