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目的探讨血清人绒毛膜促性腺激素(β-h CG)水平在甲氨蝶呤(MTX)治疗异位妊娠(EP)疗效评价中的价值。方法选取行MTX治疗的EP患者65例,其中51例患者治愈,14例治疗无效,比较治疗有效组和治疗无效组血清β-h CG含量的差异,分析血清β-h CG水平以及血清β-h CG平均下降幅度与患者疗效的关系,对血清HCG含量预测患者疗效进行ROC曲线分析。结果治疗有效组患者在治疗后1 d的血清β-h CG含量(1 268.71±25.36)m IU/ml低于无效组(1 639.75±34.78)m IU/ml,差异有统计学意义(P<0.05);在治疗后7 d的血清β-h CG含量(649.84±18.25)m IU/ml低于无效组(2 017.57±20.32)m IU/ml,差异有统计学意义(P<0.05)。不同血清β-h CG水平分层(<1 000 m IU/ml、1 000~2 000 m IU/ml、>2 000 m IU/ml)患者的治疗有效率(92.31%、73.91%、62.50%)差异有统计学意义(P<0.05)。不同血清β-h CG平均下降幅度(<5%、5%~10%、>10%)的患者治疗有效率(42.86%、81.82%、93.10%)差异有统计学意义(P<0.05)。治疗后1 d血清β-h CG含量预测患者疗效的灵敏度和特异度分别为78.57%和82.35%,约登指数为0.609,ROC曲线下面积为85.71%;治疗后7 d血清β-h CG含量预测患者疗效的灵敏度和特异度分别为92.86%和66.67%,约登指数为0.595,ROC曲线下面积为86.41%。结论异位妊娠接受甲氨蝶呤治疗后有效的患者血清β-h CG含量明显降低,其可作为预测患者预后的重要监测指标。
Objective To investigate the value of serum human chorionic gonadotropin (β-h CG) in evaluating the efficacy of methotrexate (MTX) in the treatment of ectopic pregnancy (EP). Methods Totally 65 EP patients treated with MTX were selected. Among them, 51 patients were cured and 14 were ineffective. The difference of serum β-h CG content between the treatment group and the treatment-ineffective group was compared. The levels of serum β-h CG and serum β- h CG average decline and the relationship between the efficacy of the patient HCG content prediction of the efficacy of the ROC curve analysis. Results The serum β-h CG level (1 268.71 ± 25.36) m IU / ml in the effective group was significantly lower than that in the ineffective group (1 639.75 ± 34.78) m IU / ml at 1 d after treatment (P < 0.05). The level of serum β-h CG at 64th day (649.84 ± 18.25) m IU / ml was lower than that of ineffective group (2 017.57 ± 20.32) m IU / ml at 7th day after treatment (P <0.05). The therapeutic efficacies (92.31%, 73.91%, 62.50%) of patients with different serum levels of β-h CG (<1000 mIU / ml, 1000-2000 mIU / ml and> 2000 mIU / ) Difference was statistically significant (P <0.05). The effective rates (42.86%, 81.82%, 93.10%) of patients with different mean serum β-h CG decline (<5%, 5% -10%,> 10%) were statistically significant (P <0.05). The sensitivity and specificity of predicting the therapeutic effect of β-h CG on the first day after treatment were 78.57% and 82.35% respectively, the Youden index was 0.609, and the area under the ROC curve was 85.71%. The serum β-h CG content The sensitivity and specificity of predicting the efficacy of the patients were 92.86% and 66.67% respectively, the Youden index was 0.595, and the area under the ROC curve was 86.41%. Conclusions Serum levels of β-h CG in patients with ectopic pregnancy who are effective after methotrexate treatment are significantly lower, which may be used as an important monitoring index to predict the prognosis of patients.